Contact Centre Form (CCSRCH-1)
Organisational Services – Financial Services – Contact Centre
Search Credit Card Payment Form
SEARCH NO: .............................................................................................. APPLICANT:............................................................................................................................ ................................................................................................................................................. ................................................................................................................................................. ACCOUNT NO: AMOUNT: ............................................. ............................................. ( ) .................................... Master Card Visa Card
Contact Telephone Number: Bank Card Card Number:
Expiry Date:
CCV #:
(Last 3 digits on back of card)
Signature of Card Holder: .......................................................................................................... Receipt Required Yes No
(GCCC Office Only) Additional Information / Comments ............................................................................................... ........................................................................................................................................................ ........................................................................................................................................................ ........................................................................................................................................................ Name: .............................................................. Date / / Payroll Number ...........................................
Smartpay Transaction Number .........................................................................................................
Credit Card applications are accepted for one-off or infrequent users of Council’s Corporate Search Request Form. If you are a regular user of Council’s Search Request Form, we recommend the use of a Sundry Debtor account to pay for searches. This is Council’s preferred method of payment. A Sundry Debtor Account for Searches saves our account customers considerable time by allowing their applications to be loaded by Council on the day of receipt, even if faxed. Sundry Debtor accounts will be issued if Council’s Credit requirements are met. Please contact the Customer Contact Centre on 1300 366 659, if you would like an application for a credit account emailed, faxed or posted, or you have any questions.
Thank you for your business Please Fax Back to: 07 5581 6841
Last Updated: 08/07/2008 Revision 5 (Last Modified 02/07/2008) Page - 1 of 1