02.4 - Credit Card Debit Authority Form · OPW18/0008

              CREDIT CARD DEBIT AUTHORITY
                   COUNCIL AUTHORITY: Noosa Council

Name:         Building Approvals Group Australia Pty Ltd
Address:      Unit 3/9 Exeter Way, Caloundra Qld 4551
Telephone:    1300 885 229 / 0419 731 227
Fax:          (07) 5438 1319
Email:        [email protected]


  Type of Card:           VISA            Expiry Date:             11/18
  Card Number:      4564 8070 0671 3935

Card Holders Name: Gregory C Roberts



I hereby authorise the debit of an amount of $1276.00 from the above detailed
credit card.



Cardholder Signature:                          Date: 04 Jan 2018

Being for payment of:
Plumbing & Drainage Application    ☐
Concurrence Agency Referral/MCU ☐
Build Over Relevant Infrastructure ☐
Lodgement Fee                      ☐
Other (Operational Works - Jetty) ☒

Site Address: 6 Mermaid Quay NOOSAVILLE 4556 (Lot 120 on RP 842150)
Our Reference Number: 00003482