Pennant Hills War Memorial Children's Centre Direct Debit Request Form Payment by Instalments – Child’s Name : Type of Card (please circle) Visa Mastercard Cardholder’s Name: (please Mr/Mrs/Ms Phone: Card Number: Expiry Date : / Cardholder’s Signature: Date: Option 1: Amount to be debited Frequency Starting Date (i.e. weekly etc) Option 2: Date Amount
Pennant Hills War Memorial Children's Centre Direct Debit Request Form – Payment by Instalments Child’s Name : Type of Card (please circle) Visa Mastercard Cardholder’s Name: (please Mr/Mrs/Ms Phone: Card Number: Expiry Date : / Cardholder’s Signature: Date: Option 1: Amount to be debited Frequency (i.e. weekly etc) Starting Date Option 2: Date Amount
DIRECT-DEBIT-FORM-instalments.docx