Visa Payment Authority · OPW18/0094

 VISA PAYMENT AUTHORITY

NOOSA BUILDING CERTIFIERS




   Client Name:          Noosa Building Certifiers             Your Cust. Ref:         20180091



   Postal Address:       Po Box 914 Tewantin

   Phone No:              (07) 5455 6081                               Fax No:          (07) 5455 6084

   Email Address:        [email protected]                     Date:           19/04/2018



Council                                  Noosa Council

Product Order                           opp wks

Address                                  2 Witta Circle Noosa Heads QLD 4567

Signature:                                                                Date:   19/04/2018




  Payment Details
    (Please tick)      Amount of Payment:     $463.00
        Amex           Card Number:         4 5 6 4       8 0 7 0      1 6 7 7          8 2 6 6     (Please Print Clearly)

        MasterCard     Expiry Date:           02   / 22
     X Visa            Cardholder’s Name:     Noosa Building Cert                     Phone:   0437 783 608
                       Cardholder’s Signature:                                    Date:   19/04/2018




 Office Use Only
 Receipting officer:                  Date:          /    /         Receipt Number:




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