Ref: Agreement to Debit Credit Card Books Order Date* Date Format: MM slash DD slash YYYY Grade*Name: Parent*for the authorization for CIA to debit Mr./Mrs. First Last Name: Student*This agreement is between Caribbean International Academy (CIA) and Mr./Mrs. First Last Master/Visa card no.*Card Exp Date:*Order Number #*Book order total amount USD*Parent Signature* I agree and give my permission to charge my card.
