Credit Card Payment Form

 

* Mandatory Fields

 

Credit Card Type:

Invoice Number:

* Company Name:

* E-mail:

* Card Number:

* Card Expiry Date:  Month      Year
  

* Card Verification Number:

   (last 3 digits on the rear of your credit card)
* Amount:
Comments:
 

 

All Credit Card Payments will incur a surcharge of 2%

This form is not secure! Messages that you send may be intercepted by others. Classic Web Solutions cannot guarantee and will not be held liable for the privacy, security, or delivery of the form that you send.
If concerned about displaying your credit card details on this form, please call us on 03 5996 6053, to make your payment.

 

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