Please fill out the following credit / debit car mandate and fax back to us for instant trackside service.
Dataspares Acquisition Ltd, 4 Southbrook Mews, Southbrook Road , London SE12 8LG
Credit/Debit Card Mandate
Please complete parts 1- 5 to authorise us to claim payments directly from your Visa or MasterCard Account.
1. Your Details
Surname ................................... Forename(s) ......................................................
Are you the card holder? Yes ___ No ___ (Please tick)
Company Name ....................................................
2. Cardholder's Name (as shown on card)
......................................................................................................
3. Cardholder's Full Address
.......................................................................................................
.............................................................................
.............................................................................
Post Code ......................
Tel ............................................
4. Type of Card: Visa __ MasterCard __ Other _______________
Card Number ..................................................... Issue No .............
Expiry Date .................. Security Code ......... (3-digit security code at the end of the signature strip)
5. Your authorisation to Dataspares Acquisition Ltd to claim amounts due from the above company's credit or debit card and signature.
I authorise you to charge my or the company's credit or debit card variable amounts in respect of payments as and when they become due.
I understand that Dataspares Acquisition Ltd will advise me of the amount to be paid and the dates the payment is due.
I understand that this authority in favour of Dataspares Acquisition Ltd will remain in force for the duration of trading or until such time as I cancel it in writing to the Dataspares Acquisition Ltd.
Cardholder's signature ......................................... Date ..........................
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