CREDIT CARD AUTHORIZATION FORM Navitas at UMass Boston accepts VISA, MasterCard and Discover credit card payments. Please complete the form, fax or scan and email back to Navitas at UMass Boston: The Navitas at UMass Boston Fax Number in the USA is +1-617-287-7644 Email:
[email protected] Name as shown on credit card (exact) Credit card type
Visa
MasterCard
Discover
Credit card number Expiration date (mm/yyyy) Security Code (last 3 digits on the back of your card) Amount to be charged in US Dollars Billing address (please print clearly) Email address for payment receipt Reference
Student name: Navitas identification number (found on your offer letter):
Signature of credit card holder: ___________________________________________ Date: ___________________________________________ Last updated July 17, 2014
