2010 Credit Card Authorisation Form

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					                             2010 CREDIT CARD AUTHORISATION FORM

I/We, _________________________________________________________________________________________

of ___________________________________________ and parent/s of ____________________________________


hereby authorise Brisbane Montessori School to debit my/our credit card automatically once a term for the payment of
tuition (the total amount as per the table below).

Our credit card details are noted below:

          Mastercard / Visa
          Cardholders name
          Credit Card Number
          Expiry Date

Please use the following table to calculate your term charge:

                 Add across each row            Per Child    1st Child       2nd Child      3rd Child       Total
            and then down the Total column

Tuition: 3 - 6 Junior School
                                                 $1806.00
3 - 4½ years attending 9am - 12noon
Tuition: 3 - 6 Junior School
3 - 4½ years attending 9am – 3pm
                                                 $2231.00
which includes a full day premium
Tuition: 3 - 6 Junior School
                                                 $1806.00
4½ - 6 years attending 9am – 3pm
Tuition: 6 - 12 Primary School                   $1806.00
Voluntary Building Fund Donation                   $150.00
Less Sibling Discount – 2nd Child                  -$90.30
Less Sibling Discount – 3rd Child                  -$90.30
                                                                                         Total Amount $

I/We also request that Infant and Toddler Program Tuition for the amount of $______________ also be deducted.

Signed ____________________________________________________________________

                2010 TERM
                                             5 February          30 April                23 July          15 October
              PAYMENT DATES

We acknowledge that a late payment penalty will apply of $100 per term will apply if the payment schedule noted above
is not adhered to.

Cardholders Signature: ______________________________                    Date:           __________________________


Brisbane Montessori School                                                                                                    1
ABN: 29010 233 333
Mactier Street, Fig Tree Pocket QLD 4069                                                                    2 November 2009