Credit Card Payment

CREDIT CARD PAYMENT

PAYMENT TO:

Australian Music Examinations Board (Qld), ABN 76 337 613 647

PO Box 21 Ashgrove Qld 4060

PAYMENT FROM:

Enroller ID

(if known)

Parent’s Name:

Parent’s Address:

Postcode

Parent’s Phone:

$

PAYMENT DETAILS: Please debit my credit card for the amount of





Mastercard

Visa

(Note: only Mastercard and Visa are accepted)

Card Number

/

Expiry Date

Verification Number

(Last 3 digits on Signature Panel)

Name on Card (BLOCK LETTERS)___________________________________________________________________________

Signature ___________________________________________________

Date __________________________________

PRIVACY: The AMEB is collecting personal information on this form in accordance with AMEB (Qld) systems and business processes. This form will be securely stored in the AMEB (Qld)

State Office and securely destroyed after the transaction has been completed.

----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

CREDIT CARD PAYMENT

PAYMENT TO:

Australian Music Examinations Board (Qld), ABN 76 337 613 647

PO Box 21 Ashgrove Qld 4060

PAYMENT FROM:

Enroller ID

(if known)

Parent’s Name:

Parent’s Address:

Postcode

Parent’s Phone:

$

PAYMENT DETAILS: Please debit my credit card for the amount of





Mastercard

Visa

(Note: only Mastercard and Visa are accepted)

Card Number

/

Expiry Date

Verification Number

(Last 3 digits on Signature Panel)

Name on Card (BLOCK LETTERS)___________________________________________________________________________

Signature ___________________________________________________

Date __________________________________

PRIVACY: The AMEB is collecting personal information on this form in accordance with AMEB (Qld) systems and business processes. This form will be securely stored in the AMEB (Qld)

State Office and securely destroyed after the transaction has been completed.