Please fill out this form, scan it, and send it along with the other required documents.
Language Systems International
Credit Card Payment Form
Please check the campus you are applying to:
Northeast LA (Pasadena)
Orange County
Downtown LA
South Bay LA (Torrance)
Student Name:
Last
Card Type:
Visa
First
MasterCard
American Express
Discover
Card Number:
Expiration Date (MM/YY):
Security Code:
Name on the card:
Last
First
Billing Address:
(City)
(State / Province)
(Zip code / Postal Code)
(Country)
Amount authorized to charge:
US $
I hereby authorize Language Systems International to charge the above amount to my credit card
Card Holder’s Signature:
Northeast LA Campus
408 S. Rosemead Blvd.
Pasadena, CA 91107
Phone: 626-284-9852 / Fax: 626-239-3552
Email: northeast@languagesystems.edu
Downtown LA Campus
3450 Wilshire Boulevard, Suite 900
Los Angeles, CA 90010
Phone: 213-385-3665 / Fax: 213-385-7908
Email: la@languagesystems.edu
Date:
Orange County Campus
750 South Placentia Avenue
Placentia, CA 92870
Phone: 714-572-1771 / Fax: 714-579-0498
Email: oc@languagesystems.edu
South Bay LA Campus
3528 Torrance Boulevard, Suite 304
Torrance, CA 90503
Phone: 310-792-7770 / Fax: 310-755-3117
Email: torrance@languagesystems.edu
Last revised 09/06/2018