credit_card_agreement_and_authorisation

Document Sample
credit_card_agreement_and_authorisation Powered By Docstoc
					TAFE SA Network Services – City West Child Care Centre
Credit Card Payment Authorisation
Customers Authority

I/WE_________________________________________________________
                         (Name of customer as it appears on their billing account)

Authorise City West Child Care Centre to arrange for funds to be taken from my/our credit card
subject to the conditions below.

________________________________________________                              ____________________

Signature                                                                     Date


________________________________________________                              _____________________
Signature                                                                     Date




Details of the Credit Card to be used

I/WE request that City West Child Care Centre use my/our credit card to pay my/our child care bill
in accordance with our Agreement and subject to the following conditions:

Frequency

Weekly:                  Monday                         Friday

Fortnightly:             1st Monday                     2nd Monday            1st Friday              2nd Friday

Monthly:           1st      2nd        3rd     4th               Monday               Friday
                         (Please circle one)

Period From _____________ TO ______________                       OR        Ongoing until further notice
                            (Date)             (Date)



Payment Details

Child Name ____________________________________

Cardholder’s Name (as it appears on the card) ___________________________________


Card Number



Expiry Date _______ / ________                                         CVV Verification


Card Type       VISA                 MASTERCARD                        AMEX



Amount $ __________________                               OR                  Balance of my tax invoice

_______________________________________________                               _____________________
Cardholders Signature                                                                 Date
Credit Card Payment Authorisation Conditions:

   1. Cardholder to complete the authority form

   2. Declined transactions will incur a $10 processing fee.     This will be added to your account



   3. Deductions will be processed either on a Monday or Friday to coincide with the weekly
      billing run


   4. A receipt will be issued for your records and placed in your parent pigeon hole


   5. Admin staff may request to sight or obtain a photocopy of your credit card


   6. It is your responsibility to notify the centre in writing of any changes to details relevant to
      your credit card e.g. cancellation and / or expiry date




      Please note:
      All credit card details are securely stored and kept strictly confidential

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:5
posted:1/2/2012
language:
pages:2