CREDIT CARD PAYMENT DETAILS

Date__________ Job Number__________________

I, ______________________________________ hereby give authorisation for
Anderson Camera Repairs to deduct from my Credit card the amount of

$______________ (Total of repairs & freight)

Credit Card type (Please tick)
Mastercard     Visa     Amex     Bankcard

Card number ...................-....................-...................-....................

Expiry date______________

Confirmation of final delivery address:

Name. _________________________________________________

Address ________________________________________________

Please FAX to (07) 3821 0006
E-mail- admin@andersoncamera.com.au