Credit / Debit Card - Payment Authorisation Slip
ADVERTISEMENT
1Germany Consular
Network
CREDIT / DEBIT CARD – PAYMENT AUTHORISATION SLIP
If you are applying for Consular Services, including Emergency Travel Documents, you can pay by debit or credit card using this form.
The cards we accept are Visa and MasterCard credit and debit cards.
Please complete this form and enclose it with your application. A separate credit card authorisation slip should accompany each
application, e.g. if you are applying for two Emergency Travel Documents, for instance for yourself and another person, using the same
credit card details for both, you will need to complete two payment forms. Actual fees at the time of application may fluctuate due to
exchange rate movements. We will calculate the correct fee on your behalf. Your signature on this form indicates acceptance of these
terms and authorises us to charge the actual fee to your card. We will issue you with a receipt showing the correct fee. Please check
the current fees on the Consular Fees Order on display in our waiting room.
Applicant’s Details
Name:
Date of Birth:
Daytime telephone or mobile
number:
Services requested:
Consular/Notarial/Documentary or Other –
Emergency Travel Document
Please specify in box below
□
– if service to be returned by registered post
Postage
(
)
amount to be entered by post
□
□
□
□
Payment type:
VISA
MasterCard
VISA Debit
MasterCard Debit
Card Number:
/
Expiry Date:
;
Card Security Code:
(3-digit number on the signature panel)
Cardholder’s Name: ____________________________
Cardholder’s Address: ___________________________ Cardholder’s signature
_____________________________________________
_____________________________________________
Cardholder’s Tel. No:
Cardholder’s email address: __________________________________________
For use by Consular Section only:
Processed on
/
/
By:______________
–
– MOTO –
–
SERVICE
POST
DATE
REF
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Business