Credit payment by fax
Use this form to obtain extra security when passing information
about your credit card.
Print form on your printer, complete and fax-return to us on:
- Fax: + 61 8 8672 3990
|
Payment by credit card
|
| Please print details |
We accept M'card/Visa/Bankcard |
| Name on card:
* _______________________________
number on card:
* _______________________________
expiry date on card:
* _______________
|
*Type of card: (tick
one only)
Mastercard _____
Visa _____
Bankcard _____
|
| I authorise the following transaction
from my credit card:
*amount $ ______________
*date __________________
*being for _______________________
________________________________
|
- Thank you
- Please fax-return to our office.
- Our fax number is + 61 8 8672 3990.
Signature:
_____________________________
|
|
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