Payment Advice

Payment Advice Form Beenleigh.biz
(a Division of SupplyLink International Pty Ltd)

Name:	__________________________________
Date:	______/________/________
Address:	__________________________________ __________________________________ __________________________________
Phone:	__________________________________
Fax:	__________________________________

Please enter either the details of service required, invoice number or attach a copy of the order form that you are paying for:

Details of service (e.g. Listing, Web Design, Hosting):	__________________________________ __________________________________
Invoice # (if applicable):	__________________________________
Reseller ID:	__________________________________
Domain name (s):	__________________________________
Order form attached:	Yes No
Payment method:	Cheque Money Order Credit Card

Payment by Cheque or Money Order

I have enclosed a cheque for $___________
Please make cheques payable to SupplyLink International Pty Ltd and write your domain name or invoice number on the back of your cheque. Mail your payment, together with this form to the address at the bottom of this page.

Payment by Credit Card

Type of card:	Bankcard MasterCard VISA
Name on card:	_________________________________
Card number:
Compulsory three digit CVV code:	_________________________________
Expiry date:	______/________/________
Cardholder signature:	__________________________________

Please tick one box:

Please make a one-off charge to the credit card I have indicated above for the following amount: $___________

Each quarter, please charge the hosting service I have requested to the credit card I have indicated above until I cancel the services, which I may do at any time by notifying SupplyLink International Pty Ltd in writing. I understand that SupplyLink International Pty Ltd will send an invoice to me via email seven days before any charge is made to my card, so that I have the opportunity to check/dispute the charges before they are actually incurred. I authorise the amount of $_____________to be charged to my credit card now.

Please mail this form to:
SupplyLink International Pty Ltd
PO Box 313
Beenleigh Qld Australia 4207

THANKYOU for your payment