Credit Card Authorisation Form (Visa And Mastercard Only)

 

 

CREDIT   C ARD   A UTHORISATION   F ORM   ( Visa   a nd   M asterCard   o nly)  

Please   a ttach   a   c opy   o f   y our   c redit   c ard   ( front   s ide   O NLY)   a nd   a   c opy   o f   y our   E mirates   I D   C ard   o r   P assport   C opy.  

Personal   I nformation

Student   N ame

Academic   Y ear

Grade

Parent(s)   N ame(s)

Contact   N umber   a nd   E mail

Payment   D etails

Registration/Re-­‐Registration   D eposit

Debit   D ate

dd

mm

yy

Amount

AED  

Amount   i n   w ords

Term   1   T uition   F ee

Debit   D ate

dd

mm

yy

Amount

AED  

Amount   i n   w ords

Term   2   T uition   F ee

Debit   D ate

dd

mm

yy

Amount

AED

Amount   i n   w ords

Term   3   T uition   F ee

Debit   D ate

dd

mm

yy

Amount

AED  

Amount   i n   w ords

Amount   i n   w ords

TOTAL  

TOTAL

AED

 

Credit   C ard   I nformation

Name   a s   o n   C redit   C ard

Billing   A ddress   ( credit   c ard   s tatement   a ddress)

Credit   C ard   N umber

xxxx

xxxx

xxxx

xxxx

Expiry   D ate

mm

yy

Type

Visa

Mastercard

Issuing   B ank

 

I,   _ ____________________________________________   h ereby   a uthorise   G reenfield   C ommunity   S chool   t o   d ebit   m y   c redit  

card   a s   p er   t he   a bove   a nd   c onfirm   t hat   I   h ave   r ead,   u nderstood   a nd   a ccept   t he   T erms   a nd   C onditions   d etailed   b elow.  

 

_______________________________________                                           _ _____________________  

Card   H older’s   S ignature    

 

                                                            D ate  

 

TERMS   A ND   C ONDITIONS  

1)   G reenfield   C ommunity   S chool   r eserves   t he   r ight   t o   a ccept   o r   r eject   a ny   C redit   C ard   A uthorisation   a t   i ts   s ole   d iscretion   w ithout   t he   n eed   f or   j ustification.  

2)   T he   C ustomer   s hould   o nly   s ubmit   o ne   C redit   C ard   A uthorisation   ( CCA)   f orm   f or   a n   A cademic   Y ear.     G reenfield   C ommunity   S chool   a ccepts   n o   l iability   f or   d uplicate   c harging   s hould   t he   C CA   f orm   b e   s ubmitted   t wice.  

3)   T he   C ustomer   a ssumes   f ull   l iability   t hat   t he   i nformation   p rovided   b y   t he   C ustomer   h erein   a bove   i s   c omplete,   a ccurate,   t rue   a nd   r eliable,   a nd   G reenfield   C ommunity   S chool   i s   u nder   n o   o bligation   t o   v erify   i t.  

4)   I t   i s   t he   r esponsibility   o f   t he   C ustomer   t o   e nsure   t hat   s ufficient   f unds   a re   a vailable   i n   t he   a ccount   a t   t he   t ime   p ayment   i s   d ue.  

5)   I t   i s   t he   C ustomer’s   r esponsibility   t o   e nsure   t hat   t he   p ayment   i s   c orrectly   a nd   t imely   r eceived   b y   G reenfield   C ommunity   S chool.     G reenfield   C ommunity   S chool   a ccepts   n o   l iability   w hatsoever   i n   t his   r espect   a nd   i s   u nder   n o   o bligation  

to   n otify   t he   C ustomer   o f   a ny   o utstanding,   i ncorrect,   r ejected   a nd/or   d eclined   p ayments,   w hatever   t he   r eason.  

6)   G reenfield   C ommunity   S chool   m ay,   a t   i ts   s ole   d iscretion,   l evy   a   c harge   f or   e ach   p ayment   n ot   p rocessed   d ue   t o   i nsufficient   f unds   o n   t he   C redit   C ard.  

7)   If   any   transaction   is   found   to   be   incorrect,   unauthorised   or   fraudulent,   Greenfield   Community   School   reserves   the   right   to   reverse   the   transaction.   However,   the   Customer   remains   bound   to   immediately   make   the   payment   to  

Greenfield   C ommunity   S chool   b y   t he   d ue   d ate.    

8)   T he   C ustomer   m ay   t erminate   o r   c ancel   t his   t ransaction   o nly   i n   w riting   b y   g iving   G reenfield   C ommunity   S chool   n ot   l ess   t han   f ifteen   ( 15)   w orking   d ays   p rior   n otice.     T he   w ritten   n otice   s hould   b e   d elivered   p ersonally   b y   t he   C ustomer  

to   G reenfield   C ommunity   S chool’s   F inance   D epartment   o therwise   t he   c ancellation   w ill   n ot   b e   p rocessed.      

9)  Any  payment   not  processed  due  to  interrupted  service  or  technology  problems  or  errors  beyond  the  Customer’s  control  shall  not  excuse  the  Customer  from  his/her  obligation  to  make  the  requested  payment  on  the  due  date,  

neither   r elieve   h im/her   f rom   h is/her   o bligation   t o   p ay   l ate   p ayment   c harges.     T he   C ustomer   s hall   i ndemnify   G reenfield   C ommunity   S chool   f rom   a ny   c laim,   a ction,   d amage,   l oss,   o r   e xpense   i ncurred   b y   t he   G reenfield   C ommunity   S chool  

due   t o   i nterrupted   s ervice   o r   t echnology   p roblems.  

10)   G reenfield   C ommunity   S chool   h as   t he   r ight   w ithout   l iability   t o   s uspend,   t erminate,   m odify,   d iscontinue   ( whether   t emporarily   o r   p ermanently)   t his   t ransaction   a t   a ny   t ime   a t   i ts   s ole   d iscretion   f or   a ny   r eason   w hatsoever   w ithout   t he  

need  for  justification  or  notification  including  rejecting  any  processed  payment.    In  such  case,  the  Customer  will  be  obliged,  to  make  the  payment(s)  to  Greenfield  Community  School,  via  an  alternate  payment  method  acceptable  to  

Greenfield   C ommunity   S chool   b y   t he   d ue   d ate.  

11)  The  Customer  assumes  all  risks  inherent  to  payments  through  credit  card  and  shall  not  hold  Greenfield  Community  School,  its  subsidiaries,  affiliates,  shareholders,  directors,  representatives,  agents  and  employees  liable  for  any  

claim,   a ction,   d emand,   d amage   o r   l oss   a s   a   r esult   o f   t his   t ransaction.  

12)   G reenfield   C ommunity   S chool   h as   t he   r ight   t o   a mend   a ny   t ime   a t   i ts   s ole   d iscretion   t hese   T erms   a nd   C onditions   w ithout   t he   n eed   f or   p rior   n otification   t o   t he   C ustomer.  

13)   G reenfield   C ommunity   S chool’s   f ailure   t o   i nsist   u pon   o r   e nforce   s trict   p erformance   o f   a ny   p rovision   o f   t hese   T erms   a nd   C onditions   s hall   n ot   b e   c onstrued   a s   a   w aiver   o f   a ny   p rovision   o r   r ight.  

14)   T hese   T erms   a nd   C onditions   a re   g overned   b y   t he   l aws   o f   t he   E mirate   o f   D ubai   a nd   t he   f ederal   l aws   o f   t he   U nited   A rab   E mirates   a s   a pplicable   t o   t he   E mirate   o f   D ubai.   A ny   d ispute   a rising   t hereof   s hall   b e   r eferred  

to   t he   c ompetent   C ourts   i n   D ubai.