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    This document is a credit card deduction authorization form submitted to the Department of Immigration & Border Protection. It contains details of the debtor such as name, address, contact information and account reference. It also includes the credit card details like the card number, expiration date and name on the card to authorize deduction of a payment of $50 to be paid on the 8th of each month for an installment arrangement. The completed form should be returned by mail, fax or email to the listed address to process the payment from the credit card.

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    This document is a credit card deduction authorization form submitted to the Department of Immigration & Border Protection. It contains details of the debtor such as name, address, contact information and account reference. It also includes the credit card details like the card number, expiration date and name on the card to authorize deduction of a payment of $50 to be paid on the 8th of each month for an installment arrangement. The completed form should be returned by mail, fax or email to the listed address to process the payment from the credit card.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    10 views1 page

    Img PDF

    Uploaded by

    Francisco Fischer
    This document is a credit card deduction authorization form submitted to the Department of Immigration & Border Protection. It contains details of the debtor such as name, address, contact information and account reference. It also includes the credit card details like the card number, expiration date and name on the card to authorize deduction of a payment of $50 to be paid on the 8th of each month for an installment arrangement. The completed form should be returned by mail, fax or email to the listed address to process the payment from the credit card.

    Copyright:

    © All Rights Reserved
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    of 1

    1t10t2014

    Gredit Card Deduction Authorisation Form


    The completed form should be returned either by mail, fax or email (scan form with signature) to the
    Department of lmmigration & Border Protection to authorise deduction of the payment indicated from
    your credit card.
    Debt Management Unit
    Financial Shared Services
    Department of lmmigration & Border Protection
    PO Box 25
    Belconnen ACT 2616
    DEBTOR DETAILS
    Name
    Address
    or email : debtors@immi.gov.au
    orfax: 0262642005
    Rupinder KAUR
    42 Balmoral Street, HAWTHORNE
    Email: rimpy.rupinder09@gmail.com
    Mobire:
    O ll
    1o3
    U 33?
    O
    rerephone:
    169197
    Note: lf more than one account outstanding, payment will be allocated
    against the oldest invoice first
    Contact Numbers
    Account Reference
    GREDIT CARD DETAILS
    Card number
    Expiry date
    Name on card.
    Authorised signature
    For I nstalment Arrangements
    -
    the scheduled amount and
    date of payment
    ET2 55.;L
    ottu
    1006
    r>9/n
    {4i
    S\ fJ, ,0T N 0q fl h4r, fr
    Lu"b,".rbl /cebgD
    Amount: $ 50.00 Payable on the 8th day of the month

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