Label & Mint
Credit Card Authorisation Form
Please complete all fields. You may cancel this authorisation at any time by contacting us by email at melvin@labelandmint.com.au. This authorisation will remain in effect until cancelled.
Credit Card Informatio
Car Type
[radio* cardtype use_label_element "MasterCard" "VISA" "Discover" "AMEX" "Other"]
Cardholder Name (as shown on card):
Card Number:
Expiration Date (mm/yy):
/
CVC number
Cardholder ZIP Code (from credit card billing address):
I,
, authorise Label & Mint Pty Ltd to charge my credit card above for agreed upon services. I understand that my information will be saved to file for future transactions on my accoun
Customer Signature
Date
