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Georgetown Law Office of Student Accounts Phone 202-662-9057 Fax 202-393-8297 Credit Card Payment Authorization Form Please complete the following form and FAX to the Cashier s Office Personal Information Name Print GU ID If Applicable E-mail Address Telephone Purpose Term/Semester CREDIT CARD INFORMATION Please select card type MASTERCARD VISA DISCOVER Card Number Expiration Date Name as it Appears on Card Credit Card Billing Address Amount U.S. Cardholder s Signature Date Please Fax...
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