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					TAFE SA Network Services – City West Child Care Centre
Credit Card Payment Authorisation
Customers Authority

                         (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:


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

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