TGTGA A use only
This form, when completed, wil be classified as '
For official use only'.
For guidance on how your information wil be treated by the TGA see: Treatment of information provided to the TGA at
<https://www.tga.gov.au/treatment-information-provided-tga>.
Credit card payment to the Therapeutic
Goods Administration
Credit card payments can be made for Therapeutic Goods Administration (TGA) invoices and
applications.
Please note that the TGA accepts payments by Mastercard, Visa and AMEX.
Did you know?
You can now pay various TGA invoices and applications online. Visit our website for details and
payment:
Payment options.
Submitting the form
Payment using this form can be made:
by post to
Therapeutic Goods Administration
Product Bil ing and Industry Assistance team
PO Box 100
WODEN ACT 2606
by email to
xxxxxxxxxxx@xxxxxx.xxx.xx
by fax to
02 6232 8222 (TGA Product Bil ing and Industry Assistance team)
Enquiries
Enquiries should be directed to the Product Bil ing and Industry Assistance team by calling
02 6221 6900. Unfortunately, the TGA is unable to take credit card payments over the phone.
PO Box 100 Woden ACT 2606 ABN 40 939 406 804
Phone: 1800 020 653 Fax: 02 6232 8605 Email: xxxx@xxx.xxx.xx
https:/ www.tga.gov.au
TGA credit card authorisation
*Please do not post this form in if you have already faxed or emailed it to TGA*
Attention: Product Bil ing and Industry Assistance team I authorise payment to the Therapeutic Goods Administration (TGA) for the amount of:
$
AUD
Being payment for:
Client ID/Company
name
Company address
Contact phone number
Credit Card type – please tick
Mastercard:
Visa:
AMEX:
Credit Card number
Expiry date
Card holder’s name
Card holder’s signature
Date
If you require an electronic receipt of payment, please provide your email address below:
Email
Credit card payment to the Therapeutic Goods Administration (November 2018)
For
Page 2 of 2
official use only
Document Outline
- Credit card payment to the Therapeutic Goods Administration