LUX					

Credit and Debit Card Payments					
Use this form when the Cardholder is not present.					
					
Please ensure you collect the following information from the cardholder by phone or fax (not email)					
Make sure you inform the cardholder of the total transaction value (including the currency )					
and obtain their authority to debit this from the card					
					
					
Card type:					
	"(Visa, MasterCard, Visa Electron, Maestro or Solo)"				
					
Name & Address of Card issuing Bank					
(for overseas transactions only)					
					
Card No:					
					
Name and initial exactly as they appear on their card:					
					
Valid from date (if on card)					
					
Expires end date					
					
Security code					
			(The security code is the last 3 or 4 digits of the number printed on the signature strip on the back of the card)		
					
Card's issue number  (where present)					
	(for UK issued Maestro and Solo only)				
					
Total Transaction Value	£	p			
					
Billing Name 						
						
House Number of Billing Address 						
Billing Address 						
						
						
						
Billing Postcode ( please provide full postcode)						
						
Contact Telephone number						
	(We do not except mobile numbers)					
						
Lux invoice number or payment detail