Credit Card Payment Form
You must ensure the amount stated below is consistent with the fee payable on
your completed application/request. If you are uncertain of the correct fee
please contact the courts on 1300 352 000.
The form must accompany any mailed applications or requests that require
payment (unless payment is made via cheque or money order). Please do not fax this form
unless directly requested to do so by the courts.
Attach this form to your application/request.
CARD HOLDER'S NAME (as appears on the card):
CARD HOLDER’S ADDRESS:
PHONE NUMBER: ( )
TOTAL AMOUNT: AUD$
I authorise the Family Court and Federal Circuit Court to debit my credit card with the amount shown
. I certify that I am over 18 years of age.
CARD HOLDER’S SIGNATURE _____________________________
Due to privacy issues the courts will not issue credit card transaction receipts. Instead, the
Family Court and Federal Circuit Court receipt should be taken as evidence of the credit card
Please note that when you email the courts the content of your message, as it is
transferred across the Internet, may not be secure. If you have concerns about the
security of your message, please contact the courts directly by phone, fax, or post.
OFFICE USE ONLY
Authorised by Executive Director Client Services