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CREDIT/DEBIT CARD RECEIPT …

Tags: american express, card receipt, cardholders, contact name, credit debit, customer details, debit card, details name, discover card, finance code, postcode, receipt number, source of funds,
Pages: 1
Language: english
Created: Tue Oct 23 14:15:34 2007
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CREDIT/DEBIT CARD RECEIPT                                             FOR INCOME OFFICE USE
CUSTOMER NOT PRESENT                                                             Receipt Number:
                                              TO BE FILLED IN BY UNIVERSITY DEPARTMENT HOLDING EVENT

DEPARTMENT OF                         .............................................................................................

CONTACT NAME AND TEL NO ............................................................................................

DESCRIPTION OF CONFERENCE ..........................................................................................

                                       ............................................................................................
Please attach an addressed pre paid envelope if you require a receipt sending to the customer

FINANCE CODE TO BE CREDITED                                               SOURCE OF FUNDS


                                                                                                FOR INCOME OFFICE USE ONLY
REASON RETURNED

        The card has been declined                The card has expired                   The card number is invalid


        Valid from/Expiry date missing            No Issue Number                      No Finance Code quoted/Finance Code invalid


     American Express/Discover Card                The PDQ machine is not accepting the card

       Other reason ............................................................................
CUSTOMER DETAILS

NAME ON CARD                         ..........................................................................................

CARDHOLDERS ADDRESS                  ..........................................................................................
(per statement)
INC POSTCODE                         ...........................................................................

CONTACT TELEPHONE                    ..........................................................................................

CONTACT E MAIL ADDRESS ...........................................................................................



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CARD ISSUED BY (BANK OR EQUIVALENT) ........................................................................

CARD NUMBER (On the front of the card).................................................................................

SECURITY NUMBER:(On the back of the card) .........................................................................

CARD TYPE: VISA......................................           MASTERCARD.............................................

                  MAESTRO.................................. CARD ISSUE NUMBER...................................

                  VISA/DELTA............................        JBC.............................................................

                   SOLO...................................... CARD ISSUE NUMBER...................................


VALID FROM DATE................................. EXPIRY DATE................... AMOUNT ..................


Authorisation obtained?     YES/NO               CARDHOLDERS SIGNATURE:...............................................


CARD DETAILS TO BE DETACHED AND DESTROYED AFTER TRANSACTION COMPLETION