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Dah Sing Maryknoll Convent School Platinum Visa Card Direct Debit

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Dah Sing Maryknoll Convent School Platinum Visa Card Direct Debit Powered By Docstoc
					    For Office’s Use        Dah Sing Maryknoll Convent School Platinum Visa Card
    MCS Ref: ______                  Direct Debit Authorization Form


                                                     PAYMENT ITEM
                       Maryknoll Convent School Educational Trust Charity Donation

               I would like to support the aim of the Maryknoll Convent School Educational Trust
                     by contributing a donation of HK$ _______________________________.

                                              INFORMATION OF DONOR
Name (Block letter in English):                                                  Year in Form 5 (if applicable):

Name of daughter(s) (if any):                                                    Class _____ (Year             /        )

E-Mail Address:                                                                  Mobile:

Address:



                           CREDIT CARD ACCOUNT AND PAYMENT INFORMATION
Credit Cardholder’s Name:                      Mr.         Mrs.        Ms.          Relationship with Student(s):
(The name printed on the Credit Card)


Credit Card: DAH SING MARYKNOLL CONVENT SCHOOL PLATINUM VISA CARD                                                  Get 0.4%
                                                                                                                   cash
                                                                                                                   rebate
Credit Card Account Number:
                                         4 5 1 4 - 2 2 1 2 -                               -
Card Issuing Bank: DAH SING BANK                        Card Expiry Date:                       M M /              Y Y
Signature of Credit Cardholder:                         Date:                              FOR OFFICE’S USE
                                                                                Date of Processing:          Remarks:
x
    (Same as Credit Card Account Signature)

Declaration:
1. I hereby authorize Maryknoll Convent School Educational Trust to charge my Credit Card Account
   (“Credit Card Account”) for Maryknoll Charity Donation.
2. I agree to maintain sufficient credit limit in my Credit Card Account for the donation.
3. I hereby authorize the School, in accordance with the Personal Data (Privacy) Ordinance, to use and
   exchange any information for the purpose of autopay processing.
4. Completed form should be mailed / returned to:
                               Maryknoll Convent School Educational Trust,
                               Maryknoll Convent School,
                               5 Ho Tung Road,
                               Kowloon,
                               Attn: Ms Patricia Ling
   Receipt (if necessary)
   Name shown on the receipt (if different from above):
   Address (if different from above):

     (Please mark “Confidential” on the envelope. All donation over HK$100 are tax deductible.
     Should you have any queries, please contact Ms Patricia Ling, Trust Office Tel: 2337-2112 or email to gen_off@mcs.edu.hk.

				
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