Credit card form>>>

Credit Card Fax-Payment Form

Please complete the required details and send the signed form to our following fax-number in New Zealand: +64-9-428-4652 This procedure guarantees the most secure transaction of your details. Total payment : $NZ ____________ $US ____________

Credit Card (tick one) : VISA.............. MASTERCARD Credit Card Number (16 digits): _____________________ Your name on Credit Card: _________________________ Expiry Date on Card (month/year): __________________

Your Name: _____________________________________ Your Phone- no: (includ. area code) __________________ Your Fax-no: (includ. area code) ____________________ Your Address (incl. country): _______________________________________________ Any other comments or remarks: _______________________________________________ _______________________________________________ Signature/Date: ............................................ ......./....../..... I herewith authorise Instant Immigration Services (NZ) Ltd. to debit my credit card for the above mentioned amount in NZ$/US$. Instant Immigration Services (NZ) Ltd., PO Box 513, Whangaparaoa, Auckland/ New Zealand Phone: +64-9-428-4651 / Fax: +64-9-428-4652