Fillable Autorizacin Pago con Tarjeta de Crdito

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Autorizacin Pago con Tarjeta de Crdito

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The Autorizacin Pago con Tarjeta de Crdito form is 1 page long and contains:

  • 2 signatures
  • 4 check-boxes
  • 42 other fields

Country of origin: US
File type: PDF

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Autorización Pago con Tarjeta de Crédito
Oficina de Recaudaciones
Credit Card Payment Authorization
INFORMACIÓN DEL ESTUDIANTE / STUDENT INFORMATION
INFORMACIÓN DE LA TARJETA DE CRÉDITO / CREDIT CARD INFORMATION
IMPORTANTE / IMPORTANT
Apellido Paterno Apellido Materno, Nombre / Father's Surname Mother's Surname, First Name
Número de Estudiante / Identification Number
Teléfono celular / Cell phone
Semestre académico / Academic semester
Correo electrónico / Email
Relación con el estudiante / Relationship to student
Nombre (como aparece en la tarjeta)
Cardholder’s name (as it appears on the credit card)
Teléfono celular / Cell phone
Tipo de tarjeta / Card type
Número de tarjeta
Card number
Fecha de expiración (mes / año
)
Expiration date (
month / year)
Cantidad del pago / Payment amount
Código de seguridad / Security Code
Firma del estudiante / Student’s signature
Firma del titular de la tarjeta / Cardholder’s signature
Descripción del servicio / Service description
• El formulario debe estar legible y completado en todas sus partes para ser procesado.
The form must be legible and completed in all its parts in order to be processed.
• El servicio solicitado estará condicionado a la aprobación e información de la tarjeta de crédito.
The requested service will be conditioned to the approval and information of the credit card.
• La tarjeta AMEX requerirá el código de seguridad, al momento de realizar la transacción.
For the AMEX card, the security code will be required at the time of the transaction.
Recuerde incluir una identificación con foto
(Licencia, pasaporte, identificación militar ó identificación de estudiante de la Universidad Interamericana)
Remember to include a photo ID
(License, passport, military ID or student ID from the Inter-American University)
click to sign
signature
click to edit
click to sign
signature
click to edit
Una vez completado el formulario y firmado, debe enviarlo a la Oficina de Recaudaciones de su recinto.
Once the form is completed and signed, you must send it to your campus Bursar’s Office.
OFICINA DE RECAUDACIONES - CONTACTO / BURSAR’S OFFICE - CONTACT
Recinto de Aguadilla / Aguadilla Campus
Hancy Muñiz
Director de Recaudaciones / Director, Bursar’s Office
(787) 891-0925 exts. 2753, 2752
hrmuniz@aguadilla.inter.edu
Recinto de Arecibo / Arecibo Campus
Víctor Maldonado
Director de Recaudaciones / Director, Bursar’s Office
(787) 878-5475 exts. 3290, 3291
vmaldonado@arecibo.inter.edu
Recinto de Barranquitas / Barranquitas Campus
Cristian Ríos
Director de Recaudaciones / Director, Bursar’s Office
(787) 857-3600 exts. 2056, 2057
cristianrios@br.inter.edu
Recinto de Bayamón / Bayamón Campus
Eduardo Berríos
Director de Recaudaciones / Director, Bursar’s Office
(787) 279-1912 exts. 2230, 2110
eberrios@bayamon.inter.edu
Recinto de Fajardo / Fajardo Campus
David Guzmán
Director de Recaudaciones / Director, Bursar’s Office
(787) 863-2390 ext. 2212
david.guzman@fajardo.inter.edu
Recinto de Guayama / Guayama Campus
Teresa Manautou
Directora de Recaudaciones / Director, Bursar’s Office
(787) 864-2222 ext. 2226
teresa.manautou@guayama.inter.edu
Recinto Metro / Metro Campus
Carmen Rivera
Directora de Recaudaciones / Director, Bursar’s Office
(787) 250-1912 ext. 3312
recaudaciones@metro.inter.edu
Recinto de Ponce / Ponce Campus
Brian Hernández
Director de Recaudaciones / Director, Bursar’s Office
(787) 284-1912 exts. 2220, 2021
bhernand@ponce.inter.edu
Recinto de San Germán / San Germán Campus
Carlos Segarra
Director de Recaudaciones / Director, Bursar’s Office
(787) 264-1912 exts. 7260, 7262
csegarra@intersg.edu
Escuela de Optometría / School of Optometry
Eduardo Salichs
Director de Recaudaciones / Director, Bursar’s Office
(787) 765-1915 ext. 1110
esalichs@opto.inter.edu
Facultad de Derecho / School of Law
Ileana Piñero
Directora de Recaudaciones / Director, Bursar’s Office
(787) 751-1912 exts. 2052, 2053
recaudaciones@juris.inter.edu
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Autorizacin Pago con Tarjeta de Crdito

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Completed 26 February 2021

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