Authorisation

 Making a payment for myself Making a payment for someone else
Please enter the customers email address that is applying for Fix My Credit services:
Please enter your email address:
Your Address:
I authorise Fix My Credit to debit my credit card for the total amount of $including a 1.5 percent surcharge for the services outlined in the terms and conditions of their agreement.
Details of the customer you are making a payment for to assist with their credit file:
Full Name :
Address :
Home Phone :
Mobile :

Credit Card Type : MasterCard Amex Visa
Name on the Credit Card
The first 6 digits of my credit card are:
The last 3 digits of my credit card are:
Expiry Date:
CVV
  I agree that the above details are correct, that this is my credit card and I agree to make payment.
Signed
By completing your online signature you are agreeing to the terms and conditions on this page and understand this is the same as an original signature and is binding
Your details are kept confidential