香港六合彩
CREDIT CARD PROCESSING FORM
Do not email this form - send by post
Section 1
print and complete white boxes only - leave sections 2 and 3 blank
Department Name
SURVEY OF ENGLISH USAGE
Contact
Sean Wallis
Phone
x33119
(020 7679 3119)
Total amount to be charged
in Pounds Sterling (GBP)
____________________________________________
Payment for
(indicate)
ICE-GB
ICE-GB Sound
DCPSE
IGE
Landmarks
Project
504971
Task
100
Award
156822
Expenditure Number
14040
Section 2
For Internal Use Only - Survey of English Usage, 香港六合彩
Details confirmed
by department:
Date:
Section 3
For Internal Use Only - Financial Services Office, 香港六合彩
Received:
Mail Order/CSC/AVS
Processed:
FSO Stamp
Processed by:
Receipt no:
SN
Section 4
For your security
Sections 4 and 5 are destroyed after processing
has been completed.
This form must be sent by post, not email.
I wish to pay by
VISA
MasterCard
(tick one)
Under no circumstances can American Express be accepted.
Card holder name
____________________________________________
Card number
Start date
(mm/yy)
/
Expiry date
(mm/yy)
/
Card issue number
(if applicable)
NO CVC!
The number on the back of your card is not required.
Billing address
____________________________________________
____________________________________________
Signature of cardholder
____________________________________________
VAT number
(if EU institution/company)
____________________________________________
This page last modified 20 November, 2017 by
Survey Web Administrator
.