CREDIT CARD AUTHORISATION FORM
Please print and complete this form clearly in BLOCK LETTERS. Sign and send it with your application.
Type of Card (Check one): |
VISA |
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MASTERCARD |
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Card Number: | |
Expiry Date: | |
CVC (3 digit number on back of card): |
Name as it appears on the card:
Billing address of this card:
Check items to be charged to the card:
Application fee |
Lost/Stolen fee |
Postage |
Notarial fee |
Note:
Application fee: Includes, if required, fees for emergency passports or documents of identity.
Postage Fee: Unless collected in person, passports and documents are returned by Canada Post Registered Mail. If preferred, you can provide a prepaid self-addressed express or priority envelope from either Canada Post or courier company for the return of your documents.
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. | |
Date: |