Print out this form on you printer, and fax to Richardson Prep at (647) 439-1373.
Include your credit card name (MasterCard or Visa), number, and expiry date.



Name______________________________________________

Address____________________________________________

City________________________________________________

Province ___________________________________________

Postal Code_________________________________________

Day Phone__________________________________________

Evening Phone______________________________________

Email______________________________________________

Course you desire and dates __________________________

Credit Card Name_____________________________________

Credit Card Number___________________________________

Credit Card Expiry Date________________________________

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