ABN: 25 115 960 293 PO Box 91

Tel: +61 3 9384 6516 Moonee Vale, VIC 3055

Fax: +61 3 9467 1755 AUSTRALIA

CREDIT CARD AUTHORIZATION FORM

Please print this page, complete the information and email a scanned copy to the email address listed
below.

I, _______________________________________, am the authorised holder of the following credit card:

[insert name of cardholder]

Visa / MasterCard (circle one)

Card Number: __________________________________________ Expiry Date: ____________

I hereby authorise Royal Tag to charge the above credit card for the sum of AU$ ___________________

________________________________________________ ________________________
Cardholder signature Date [DD/MM/YY]

IMPORTANT

To complete the credit card verification process, please email this form along with a copy of:
1) the front and back of the credit card, and
2) the cardholder’s photo ID (e.g. drivers licence or Passport)

Email the documents to: admin@royaltag.com.au

Your order will not be processed until we receive this information.