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1011RCP

This document is a recurring card payment instruction form for tuition or accommodation fees at the University of Southampton. It requests information such as the name of the account holder, address, contact details, card number, security code, valid and expiry dates. It also lists installment amounts and due dates for tuition fee and accommodation fee payments.

Uploaded by

Kunj Marthak
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
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34 views1 page

1011RCP

This document is a recurring card payment instruction form for tuition or accommodation fees at the University of Southampton. It requests information such as the name of the account holder, address, contact details, card number, security code, valid and expiry dates. It also lists installment amounts and due dates for tuition fee and accommodation fee payments.

Uploaded by

Kunj Marthak
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Recurring Card Payment Instruction Academic Session 2010/2011 University of Southampton Highfield Southampton SO17 1BJ Direct Line

023 8059 9599 Email [email protected]

Name of Account Holder(s)

Tuition Fees

OR Accommodation Fees

New RCP

OR

RCP Amendment

Full postal address of Account Holder

Email Address:

Telephone Number:

Please charge my credit/debit card: Card No:

Security Code No (Last 3 Digits Only)

Valid From

Expiry Date

Issue No
Where appropriate

Amounts

Instalment 1 ____._ Instalment 2 ____._ Instalment 3 ____._

Name on Card

Instalment 4 ____._

Cards Accepted (please tick) Cardholders Signature University of Southampton ID

Visa

MasterCard

Visa Debit Todays Date

Student Name

Note: Tuition Fee (ALL STUDENTS) payments are due to be taken on the 4th October 2010 and 3rd January 2011. Accommodation Payments are due to be taken on the 18th October, 17th January, 12th May and the 4th July (July instalment is applicable to long-let accommodation contracts only).

Student Services Centre, University of Southampton, Highfield Campus, Southampton SO17 1BJ United Kingdom Tel: +44 (0)23 8059 9599 Fax: +44 (0)23 8059 9595 www.southampton.ac.uk/studentservices

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