Australian High Commission
Canada
Responsibility for Bermuda

Credit Card Authorisation Form

CREDIT CARD AUTHORISATION FORM

Please print and complete this form. 

Passport and Notarial Services
Please select the following service(s) to be performed and charged to your credit card


Service 1:          		                 
Passport Application Fee and Overseas Processing Surcharge
    *Applicants aged 75 or older, please specify: 10-year passport OR 5-year passport


Service 2:		  

Postage Fee - I require the document to be mailed (via registered mail); OR
    I will collect my passport in-person from your office; OR
    I have provided my own prepaid self-addressed envelope for return postage


Service 3:
 

Emergency Passport Fee (if eligible - I have discussed this with the lodging office)

Service 4:
 
Notarial Services Fee (for applicable notarial services only)


Credit Card Details
Cardholder to complete and sign by hand (*digital signatures cannot be accepted)


Name on Card:		                                                                                                                                                               

Type of Card:		                                                   Visa  OR  MasterCard (circle one)

Card Number:		  

Expiry Date (MM/YY):		  

CCV (3 Digits):		  


Billing Address:
 

Telephone Number:		  


Signature:		   

 

 

I hereby authorise the Australian High Commission, the Australian Consulate-General, or the Australian Consulate to charge my credit card for the items marked above. All fees are charged in Canadian (CAD) dollars. I understand that the fees may be adjusted on the first of each calendar month for exchange rate fluctuations, and that my card will be charged the fees applicable on the day that the payment is processed. A listing of current fees and charges are available on the Australian High Commission’s website Travel Document and Notarial Fees