Melbourne Education Institute

RTO No: 45054 CRICOS No:03673A

Melbourne Education Institute Pty Ltd trading as Melbourne Education Institute
Level 13, 474 Flinders Street, Melbourne 3000
www.mei.edu.au
admin@mei.edu.au

Credit Card Payment Authorization Form

Sign and complete this form to authorize “Melbourne Education Institute Pty Ltd” to
make a debit to your credit card listed below.

Please complete the information below:

Student Name

Student ID

Course

Amount

CREDIT CARD PAYMENT AUTHORISATION

CARD  Bankcard   Visa
TYPE MasterCard
Credit Card Expiry Date: / /
Number
Cardholder’s Cardholder’s
Name Signature
PRINT CLEARLY
CVV (3 digit number on the back of Visa/ Mastercard)

SIGNATURE DATE

I authorize the Melbourne Education Institute to charge the credit card indicated in this authorization form
for the amount indicated above. I certify that I am an authorized user of this credit card.

Please sign and return in person at reception or scan and email to

admin@mei.edu.au