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VALENCIA COMMUNITY COLLEGE International Student Health Insurance Payment Options FOR INSURANCE PURPOSES ONLY Date: Student’s Name: Valencia Identification Number (VID): Complete Florida Address: Phone(s):

CREDIT CARD PAYMENT INSTRUCTIONS FAX to YOUR Campus:  East Campus/Winter Park 407.582.8907

 West Campus/Osceola 407.582.1364

If you are paying your insurance premium by CREDIT CARD, please include the following: Credit Card Company: Credit Card Number: Expiration Date:

Authorization Statement: I,

, give authorization to (Card Holder Printed Name)

Valencia Community College to process the health insurance premium payment to my credit card in the amount of $ (Card Holder Signature)

WIRE TRANSFER INSTRUCTIONS Wire Transfers must include the students name and their Valencia I.D. # (VID #). Wire transactions must include enough funds to cover all processing fees. Money should be wired to: Fifth Third Bank P.O. Box 630900 Cincinnati, OH 45263 ABA #: 042000314 International US dollar wire transfers to: SWIFT # FTBCUS3CC Deposited to: Valencia Community College Account #: 7440801798

/InternationalInsurancePaymentOptionForm  

http://valenciacollege.edu/international/students/documents/InternationalInsurancePaymentOptionForm.pdf

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