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CREDIT CARD AUTHORITY - PDF by crunchy

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									TO:          Shire of Busselton (FAX 97524958)
             Locked Bag 1
             Busselton 6280

                                                CREDIT CARD AUTHORITY


RE:          PAYMENT FOR

Please complete all sections below:


               Amount to be paid:

                      Card Number:

              Expiry Date of Card:
              Type of Credit Card:
                                                   Bankcard/Visa/Mastercard
                    (Please circle)
                Contact Telephone
                        Number/s:
             Card Holder’s Name:

                                Date:

         Card Holder’s Signature:



NOTE: COUNCIL DOES NOT ACCEPT DINERS CLUB INTERNATIONAL AND AMERICAN
EXPRESS CREDIT CARDS.




F:\Community Services\Admin Officer - Procedures Manual\General\Forms\CREDITCARD AUTHORITY.Doc

								
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