APPROVAL ROUTING ORDER: MD – FIN CONTROLLER (FILE)
(PLEASE INITIAL UNDERNEATH YOUR TITLE AND PASS ON TO THE NEXT PERSON)
CREDIT CARD PAYMENT AUTHORITY
All Transactions Over $500.00 must be accompanied by this form.
NOTE: Due to increased credit card fraud, please attach a copy of both your credit card and
driver’s licence to this form. Forms submitted without this information will NOT be approved.
NAME: ________________________________________________________
ADDRESS: ________________________________________________________________
SUBURB: ___________________ STATE: ________ P.CODE: __________
PHONE: (_____) _________________ MOB : _______________________
(OFFICE USE ONLY – NUMBER VERIFIED) ______________________
I hereby authorise Sydney City Motorcycles to charge my credit card:
VISA MASTERCARD BANKCARD AMEX
CARD NUMBER:_______________________________________________________
EXPIRY DATE: _____ / _____ CCV: ____________________________
CARDHOLDER NAME: ___________________________________________________
SIGNATURE: ________________________________________________________
DATE: _____ / _____ / _____ AMOUNT: $__________.____
PAYMENT FOR: __________________________________________________
PLEASE RETURN THIS FORM VIA EMAIL ASAP:
weborders@sydneycitymotorcycles.com.au
OFFICE USE ONLY:
ACCOUNT APPROVED BY: ________________________ / /
MANAGING DIRECTOR: ________________________ / /
FINANCIAL CONTROLLER: ________________________ / /
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