Australian High Commission
Canada
Address: Suite 710, 50 O'Connor Street, Ottawa, ON K1P 6L2 - Tel: 613-236-0841 - Fax: 613-236-4376

CREDIT CARD AUTHORISATION FORM

FOR USE ONLY FOR APPLICATIONS LODGED WITH OTTAWA, TORONTO AND VANCOUVER

Please print and complete this form clearly in BLOCK LETTERS.  Sign it and send it with your application.
 

Type of Card (Check one):

VISA

 

MASTERCARD

 

Card Number:  
Expiry Date:  
CVC (3 digit number on back of card):  

Name as it appears on the card:

 

Billing address of this card:

 

Check items to be charged to the card:

Application fee   Courier Fee  
Postage fee   Lost/Stolen Fee  

Note:
Application fee includes, if required, fees for emergency passports or documents of identity.


Signature:  
  I agree to pay for the goods and/or services indicated, and agree to perform the obligations set forth in my agreement with the card issuer.
Date:  

 

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