Refer to the EXADEP™ Information Bulletin or the EXADEP website (www.ets.org
/exadep/english/about/fees) for an explanation of charges and for other forms ...
Credit Card Payment Form Phone or Mail: ETS Puerto Rico Office AIG, 250 Ave. Muñoz Rivera, Suite 315, San Juan, PR 00918-1811 PH: +1-787-753-6363 Refer to the EXADEP™ Information Bulletin or the EXADEP website (www.ets.org/exadep/english/about/fees) for an explanation of charges and for other forms indicated below.
EXADEP™ Test Fees (Fees stated in U.S. dollars)
Price
Quantity Amount Due
Test registration fee in Puerto Rico and U.S.A. (include completed registration form with payment)
$85
$
Test registration fee in Latin America (include completed registration form with payment) Test registration fee in Europe (include completed registration form with payment Special Test Center (Additional fee to test at a center NOT listed as an EXADEP Authorized Test Center. Visit the EXADEP website for a listing of authorized test centers.) Additional Fees
$70 $140 $50
$ $ $
Late registration fee Score Verification Service (include completed Score Verification form with payment) Additional Score Reports (include completed Score Report Request form with payment) Rush Additional Score Reports (include completed Score Report Request form with payment) Other fees (Test Registration fee in other countries, shipping and handling, etc.)
$30 $40 $20 ea. $35 ea. $
$ $ $ $
$25 ea.
$
Publications EXADEP™ Study Guide
Total Amount
$
CUSTOMER/SHIPPING INFORMATION: First Name:
Last Name:
Street Address: City:
State:
ZIP/Postal Code:
Country:
BILLING/CARDHOLDER INFORMATION: (If different from Customer Information above) First Name:
Last Name:
Street Address: City:
State:
ZIP/Postal Code:
Country:
PAYMENT METHOD:
Credit/Debit Card
(Your card must have one of the following five logo to be accepted and processed.)
American Express
®
Card Number:
®
Discover
®
JCB
MasterCard
®
®
VISA
Expiration Date: _______ / _______ (Month)
(Year)
Cardholder Signature: By signing this form, I authorize Educational Testing Service to fill this order and charge the credit card information provided. I understand that sales tax or shipping charges may be added, depending upon the items ordered and where I live. I also understand that if the billing/cardholder information is found to be incorrect, is rejected at processing, or if additional charges are added, ETS will inform me by phone at the number listed below. After receipt of communication, if I fail to provide accurate payment information or if I refuse to accept the additional charges, my order will be cancelled.
I understand and agree to the terms and conditions referenced above. Customer Signature: Daytime Phone Number:
