Student's Name Parent's Name (if under 18) Email Address Credit Card Number (please note we do not accept American Express) Expiry Month Month123456789101112 Expiry Year Year202220232024202520262027202820292030203120322023 I give my permission for any missed fees to be charged to the card provided I understand that my account will be charged every fortnight on Tuesdays from now until I provide written notice via email to cancel my direct debit