M & P Secure Credit Card Transmission Form

This form is a secure way to pay us over the internet. The information passed between your computer and ours is encrypted when using this form, to prevent unauthorised people intercepting it.

You should use this form when sending your credit card details to us in preference to an ordinary email or fax. Please note that this is not an immediate card payment system - it transmits the card details to us in a secure way, so that we can charge your card accordingly. We only use your card details for the agreed purpose. We do not store them for future use.

We accept Master Card and Visa credit and debit cards, but not American Express.

If you have any problems then please e-mail support@m-p.co.uk


Name:*

Customer Number:*

Email:*

Re-type email:*

Reason for payment. Please indicate the exact amount to charge, if known, and any quotation or ireference numbers.

*

Maximum amount we can charge, in British Pounds (Optional) £

Credit Card Number, without spaces*

Valid from date (mm/yy)

Expiry Date (mm/yy) *

Last 3 digits on signature strip (AVC) *

Issue number (Switch only)

Visa

Master Card

 

I authorise Meadows & Passmore Ltd to charge my card.

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