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Authority Form for Credit Card Payment

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					               Authority Form for Credit Card Payment

To:                                Catholic Education Office, Sydney

Course:                            Certificate of Religious Education (NSW)

Unit Name:

Surname:

Given Names:

Address:




Telephone:

Online Application
Receipt No.


To Pay your Course Enrolment fee by Credit Card please complete the following:


Bankcard            Master Card        Visa Card       Expiry Date:   /   Amount::   $


Card Number:



I hereby authorise the Catholic Education Office, Sydney to debit my Credit
Card account with the amount specified above.




Card Holder Name: (Please Print)                     Signature:



Date: ____/____/200_

Please fax or mail this completed Authority Form to:

CEO – Religious Education & Evangelisation Team
Certificate of Religious Education (NSW)
PO Box 217
LEICHHARDT NSW 2040
Fax: 02 9568 8468

				
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