Credit Card Authorization Form - Australian Embassy Vienna
Mattiellistrasse 2, A-1040 Vienna, AUSTRIA
Fax: +43 1 513 29 08
Please complete all questions 1 - 10 and attach this form to your application
1. Credit Card (tick appropriate box)
VISA
Mastercard
2. Amount in EURO (€)
Visa application charge as per currency converter
3. Today's Date
4. Credit Card Number
5. Card Check Number
Card check numbers can be found on the back of your credit card in the signature field and generally consist of three additional digits to your credit card number.
6. Card Expiry Date
7. Cardholder's Telephone number
8. Cardholder's Name
9. Cardholder's Signature
10. Applicant's name (if different from cardholder)
Note 1: Credit Card Information will only be used for visa-charge paying purposes.
Note 2: Visa application charges adjust every 6 months on 1 January and 1 July as a result of biannual foreign exchange indexation. By signing this form, you are authorising us to deduct the correct visa application charge if you have entered the incorrect amount. Print this form