GB Computer and Design Limited | Credit Card Authorization

Date*

Invoice Number / Job Reference*

Business Name*

Card Type*

Card Number*

Name Shown On the Card*

Expiry Date*

eg : 10/20

Amount Paid (NZD)*

Type of payment*

Type of Service*

Domain Name :*

eg : gbnz.co.nz

Phone number and / or Address*

From*

DD/MM/YYYY

Please tick yes if you wish to go ahead with the payment.*

Comments

This field is for validation purposes and should be left unchanged.