32114 opw app payement · RAP15/0034

Re ER SPREE
Hr afnCexeysy.u ere) ON (ert By

Telephone: 5329 6500 i Email: [email protected]

    

CREDIT CARD DEBIT AUTHORITY

 

y bop vf?
name: yeh, MOM LE occ
Phone Number:.... 2426. LV EE oo coccccccccsscssscsssssesseesee

Postal address: LC... L0%.... VO voococcscce liveeeeses
UMA, QYEEO cco

 

Name of cardholder: MEAL... LAD Eo ove

Card Number:

A342) Wlelee) elIg) (AZ? e|
Type of Card: (isa Mastercard

Expiry Date: ! VSI

Security: [1]

, r pe 2
 Madchael Lecwecck
authorise Noosa Council to debit the above mentioned credit card

for the total of $ WO 3 : 5

 

 

 

(3-2/6.

 

Details of Payment:. IF. BAMY,... :
A. OMT OM... 7. MARE