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Childcare Fees Payment Authority Form

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email
 
Date
22/01/2019
Card Type
Visa  Mastercard  Amex  Diners  Other > 
 
Card Number
 
Expiry date
 
Security code
 
Name on card
 
By submitting this form, you give One World for Children Pty Ltd permission to debit the credit card above each Wednesday for my weekly childcare and/or evening meal fees.