Credit Card Authorization  Payment at a Canadian office abroad This is to authorize the debit of your credit card for the services specified below

Credit Card Authorization Payment at a Canadian office abroad This is to authorize the debit of your credit card for the services specified below - Description

Name of Cardholder Please print Email address Description of requested services Billing address and postal code Same as it appears on your credit card statement Name of applicant Credit Card Information Check one only Card number Expiration Date Amo ID: 37080 Download Pdf

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Credit Card Authorization Payment at a Canadian office abroad This is to authorize the debit of your credit card for the services specified below

Name of Cardholder Please print Email address Description of requested services Billing address and postal code Same as it appears on your credit card statement Name of applicant Credit Card Information Check one only Card number Expiration Date Amo

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Credit Card Authorization Payment at a Canadian office abroad This is to authorize the debit of your credit card for the services specified below




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Presentation on theme: "Credit Card Authorization Payment at a Canadian office abroad This is to authorize the debit of your credit card for the services specified below"— Presentation transcript:


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Credit Card Authorization - Payment at a Canadian office abroad This is to authorize the debit of your credit card for the service(s) specified below. Name of Cardholder Please print) Email address Description of requested service(s) Billing address and postal code (Same as it appears on your credit card statement) Name of applicant Credit Card Information Check one only Card number Expiration Date Amount for service(s)** Signature** VISA Master Card Month / Year) $ . CAD **Please be advised that the credit card payment service is offered by NBX Logistic Services (NBX). By

signing this form, you acknow - edge and agree to pay the NBX fee in order to use their service. Since the fee is independent from the amount payable to Government of Canada (GOC), it will be shown as a separate transaction on your card statement. NBX has the obligation to certify that the fee is reasonable and competitive. The non refundable fee is $1.50 per $50.00 increment (Amount for service in CAD) and is subject to change without notice. ***Section to be completed by a Canadian office abroad Canadian office abroad Processed by Date Reference Please complete this form in full and retain

at a Canadian office abroad as proof of formal authorization