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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