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CREDIT CARD DEDUCTION AUTHORITY

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CREDIT CARD DEDUCTION AUTHORITY Powered By Docstoc
					                                                                              OMB SOLICITORS
                                                                              ABN: 23715566980
                                                             Level 1, 9 Seabank Lane (PO Box 454)
                                                                           SOUTHPORT QLD 4215
                                                                     PH: 5555 0000 FAX: 5555 0055




      CREDIT CARD DEDUCTION AUTHORITY

I hereby authorise the Merchant to debit my Credit Card Account with the Debit amount and in the event of
any change in the charges for these goods/services to alter t he amount from the appropriate date in
accordance with such change.

This authority shall stand, in respect of the specified Credit Card and in respect of any Credit Card issued to
me in renewal or replacement thereof, until I notify the Merchant in writing of its cancellation.



  CARDHOLDERS NAME
    (as appears on card):


    CONTACT NU MBER:


        CARD NUMBER:


                                                                          DEBIT
          EXPIR Y D ATE:
                                                                        AMOUNT:

      DESCRIPTION OF
     GOODS/SER VICES:

                                                                           BILL
          FILE NUMBER:
                                                                        NUMBER:


            SIGNATURE:                                                      DATE:



I wish to use my Credit Card to pay for t he above goods/services supplied to me by OMB Solicitors (the
merchant) and agree to pay a 0.88% Merchant Fee for using the credit card facility.


Please note: The final content of thi s authority i s subject to the Merchant’s own legal advice and
approval by Commonwealth Bank, Card Operations.




Our Reference:

				
DOCUMENT INFO
Jun Wang Jun Wang Dr
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