L7 Assignment Payment Form Oct13
L7 Assignment Payment Form Oct13
Name:
Membership number:
100
75
100
75
100
75
100
75
Payment
This form will not be accepted unless accompanied by the correct payment.
Sterling bank draft, cheque or postal order enclosed - addressed to The Association of Business Executives
Deduct from the credit on my account (will only be approved if your account has a credit balance)
Deduct from my card details below:
Credit/Debit card payment form
My card number is
Expires end
Security code (last three digits on signature strip on back of card or four digits on front of AMEX card)
IMPORTANT NOTICE YOU MUST GIVE THE SECURITY
CODE FOR PAYMENT TO BE ACCEPTED
Cardholder name
Telephone no.
Cardholder address
Cardholder signature
Date
Date
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