Credit Card Authorisation
Use this form to pay a Freedom of Information charge by credit card
Applicant's details
Name
Phone number
Credit card details
Credit card type
Card holder's name
Credit card number
Expiry date
CCV number
Amount
Signature
Date
Privacy statement
Your personal information is col ected by the Department of Education, Skil s and Employment for the
purposes of processing the payment of a charge imposed under the
Freedom of Information Act 1982 and
related purposes. If you do not provide some or al of the information requested, the department may be
unable to process your credit card payment. Your personal information may be disclosed to other parties
where you have agreed, or where it is otherwise permitted by law. The department's Privacy Policy, including
information about how to make a complaint and access to and correction of your personal information, can be
found a
t https://www.dese.gov.au/privacy.
Document Outline