Fees are payable by - Australian Government Department of ...



Receipt number (office use only): __________________________________Name of applicant/form number: __________________________________CREDIT CARD AUTHORISATION FORMFees are payable by THAI or AUSTRALIAN CREDIT CARD. Fees paid by Thai credit card are linked to the AUD/THB exchange rate and re-aligned monthly.? The fee is payable when the application is received by the Australian Embassy, Bangkok. Applications submitted without valid credit card details will be returned to the applicant unprocessed. Credit Card Authorisation:I wish to pay the application fee using a: Thai credit cardAustralian credit cardVISA / VISA DEBITMASTERCARD / MASTERCARD DEBITCard No.:Expiry: Credit Card Issue Country : ___________________________________________________Credit Card Issue Bank : _____________________________________________________The total payable application fee is THB ______________________. I authorise the Australia Embassy, Bangkok to charge this amount to my credit card OR the correct amount if I have miscalculated the amount or there has been a change in the exchange rate. I understand that my application will be sent to the Australian Embassy, Bangkok and an incomplete application will delay processing times. Details of Cardholder:Name: ________________________________ Phone number: ______________________Address: __________________________________________________________________Email: ____________________________________________________________________Signature of cardholder: _______________________________ Date: ____/____/____IMPORTANT:Please ensure that your name and signature are identical to that which appears on your card. ................
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