FIN 04.001 Credit Card Payment Form Version No. 2

CREDIT CARD PAYMENT FORM
Please submit your completed form to Wells International College or forward to info@wic.edu.au This form can be used for providing payment to Wells International College. Please note there will be a 1.5% credit card transaction fee applied based on the transaction amount. Minimum amount for credit card payments is $50.00.
Student Name*

First NameLast Name
Address*

Billing Address Line 1

Street Address Line 2

CityState

Postal / Zip Code
Postcode*
Country*
Phone number*

Area CodePhone Number
Email*
example@example.com
CREDIT CARD PAYMENT DETAILS:

I authorise Wells International College to debit my credit card.
Credit Card Type (1.5% Credit card transaction fee applied based on the transaction amount)*

MasterCardVisa
Amount to be debited in AUD$ : (excluded the 1.5% fee)
Type of Payment is for: (e.g. tuition fee)*
I authorise Wells International College to debit my credit card with the amount shown above.
Cardholder's Name*
Cardholder's Signature*
FINANCE DEPARTMENT ONLY
Receipt No
Amount in AUDS: (After 1.5% Transaction fee)
Payment Processed by
Date

MonthDayYear
Date
FORM: FIN 04.001 Credit Card Payment Form Last Updated: June 2018, Version No. 2
Should be Empty:

CREDIT CARD PAYMENT FORM