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Student Enquiry Centre Payment Form (WM-CS-VFeb14
STUDENT CENTRE
PAYMENT FORM
A. PAYMENT DETAILS (SCHOOL OFFICE TO COMPLETE):
School/ oce:
Activity name:
Receipt Stamp
Please make your payment by (dd/mm/yyyy):_______/______/______
Amount (if GST applies, please include it in this amount.):
A/C code to be credited:
B. RETURN DETAILS
Townsville:
Please complete and return this form to:
Cairns:
Please complete and return this form to:
C. STUDENT DETAILS
Student Name: _________________________________ Student Number
D. HOW WOULD YOU LIKE TO PAY?
Students should make payment at the Student Centres (Education Central (Bld 134) in Townsville or Chancellery Build-
ing (Bld A1) in Cairns). Student Centres are open between 9.00am and 4.45pm Monday, Tuesday, Thursday and Friday and
10.30am and 4.45pm Wednesday. Payments can be made by EFTPOS or credit card only.
Student Name: _________________________________ Student Number
School/ oce: __________________________________ Activity: _______________________________________________
If you wish to pay be credit card, please provide your details below:
Amount: $_____________ Type of credit card: r Visa r Mastercard
Credit Card holder: ________________________________________________
Credit Card Number: CCV: Expiry Date: ____/____
Receipt Stamp
Credit Card holder signature: __________________________
Education, College of Arts, Society & Education
DET The Learning Place Membership
$29.70
2221.11100.0020
Christine Bird, College of Arts, Society & Education, caseacadserv@jcu.edu.au
Christine Bird, College of Arts, Society & Education, caseacadserv@jcu.edu.au
Office Use: EQL
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