SOUTHERN SPORTING CAR CLUB Inc .au



SOUTHERN SPORTING CAR CLUB Inc.

Credit Card Payment Form

SMP SOUTH CIRCUIT

Saturday 21ST April 2018

ROUND #02

INTERCLUB SUPERSPRINT SERIES FOR 2018

Competitor Name/s: _________________________________________________

Vehicle: ________________________________

Method of Payment: ______________________________________

■ Visa ■ MasterCard

Card Number: ______________________________________________________

Expiry Date: ______________________________

Card Holder Name: ________________________________________________

Amount: $______________________________________

Please note that a $2.00 card handling fee will be added to the Entry Fee

Signature: _____________________________________ Date: _____________

| |

|Office use only: |

|Date Processed: ________________ |

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