Credit Card Payment Form
Murray Children’s Centre
386 Elizabeth Mitchell Drive, THURGOONA, NSW, 2640
PO Box 789, ALBURY, NSW, 2640
Ph: c/- (02) 60519195 or 60519192
or email to: [email protected]
PLEASE COMPLETE THE DETAILS BELOW AND RETURN OR
EMAIL TO ABOVE ADDRESS
CHILD’S NAME: _____________________________________
PARENT’S NAME:
__________________________________
DAYTIME PH: ______________________________________
Please find enclosed payment of child care fees.
AMOUNT: $________________
(Please tick appropriate box)
Credit Card Type
□ Mastercard
□ Visacard
Card Number (All boxes must be completed)
□□□□ □□□□ □□□□ □□□□
Expiry Date: ___/___
Card Holders Name: ___________________________
Card Holders Signature: _______________________
DO NOT POST THIS ORIGINAL BACK IF YOU EMAIL THIS
FORM TO THE CHILD CARE CENTRE.