Credit Card Authorisation Form

CREDIT CARD AUTHORISATION FORM

Please print and complete this form clearly in BLOCK LETTERS.  Sign and send it with your application. 

 

Type of Card (Check one):

VISA

MASTERCARD

 

Card Number:

Expiry Date:

CVC (3 digit number on back of card):

 

Name as it appears on the card:

 

Billing address of this card:

 

Select the service(s) to be performed and charged to you nominated credit card:

Application fee

Lost/Stolen fee

Postage

Notarial fee

 

 

Note:
Application fee: Includes, if required, fees for emergency passports or documents of identity.

Postage Fee: Unless collected in person, passports and documents are returned by Canada Post Registered Mail. If preferred, you can provide a prepaid self-addressed express or priority envelope from either Canada Post or courier company for the return of your documents.

 

Signature:
	I agree to pay for the goods and/or services indicated, and agree to perform the obligations set forth in my agreement with the card issuer.
Date: