Baden Powell Cricket Club

CREDIT CARD PAYMENT

PAYMENT FOR: Member Subs / Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..

Amount: $ . . . . . . . . . . . . . . . . . . . . . . .

Relevant Details: (ie. MEMBER NAME) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Contact number: (IN CASE OF CARD PROBLEM) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Visa / MasterCard / Amex circle one

CARD NAME . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CARD NUMBER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

EXPIRY: . . . . . . . . . . ./ . . . . . . . . . . . .

This transaction will appear on your statement as "Super Signs".

Print this form out, fill it in and either...

... post to: 3 Seaview Rd, Frankston 3199
... or fax to: 9775 1458