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Structions for completing this form FOR SECURITY OF YOUR CREDIT CARD DO NOT ATTEMPT TO ATTACH THIS FILE TO AN E-MAIL! Fill in the Form SIGN THE FORM FAX to 805-437-8431 with a copy of the front and back of the credit card being used. Payments will be processed within 48 hours. We will not notify you when the payment has been placed on the account. Students may access their account through My CSUCI . I hereby authorize California State University, Channel Islands (CSUCI) to charg.

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