Australian Embassy
Ireland

Credit Card Authorisation Slip

Credit Card Authorisation Slip

 

NOTE: Only Mastercard or Visa Cards can be debited without the cardholder being present.

FEES CHANGE ON A MONTHLY BASIS. You will be charged the fee current at the time of lodgement.

Registered Post fee will be automatically included unless otherwise indicated.


Please charge my Mastercard/Visa Account No:

__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __

Security Code (last three digits on reverse of card):

__ __ __

Expiry __ __ /__ __  Amount: € ___________

Cardholders Name: ____________________________

Cardholders Signature: _________________________


I agree to pay for the goods and/or services indicated and
agree to perform the obligations set forth in my agreement
with the card issuer.