Credit Card Authority Form

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CREDIT CARD AUTHORITY FORM

Applicant’s Name:

Passport Number:

Application Category

(VISA / OCI / PPT / PIO /

MISC):

Web Reference Number:

(If Available)

Total Fee:

CREDIT CARD HOLDER

(FULL NAME ON CARD):

VISA 1.95

MASTERCARD 1.95

S/Charge

Card Type:

CARD NUMBER:

EXPIRY DATE:

AMOUNT TO BE DEBITED: AUD $______ (INCL. 1.95

Credit Card Surcharge)

I authorise VFS Services Australia Pty Ltd to debit my credit card for payment of the above

mentioned application.

Date: _______________

Credit card holder’s signature:_________________________________________

Note:

 No “on behalf of” signatures permitted.

 Signature must be that of the card holder only.

 Please attach copy of credit card (front only).

VFS Services Australia Pty Ltd

C/IND/AUS/CC/RF/01

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Parent category: Business