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Credit or Debit Card Authorisation Form

This document provides instructions for paying registration transfer fees by credit or debit card. It states that the cardholder authorizes VicRoads to charge the card for the transfer fee plus a card payment fee. The cardholder is responsible for ensuring their card details are correct and there are sufficient funds to cover the payment within 14 days. If the payment fails, VicRoads will notify the cardholder and give them 7 days to provide an alternative payment before taking action like suspending the registration.

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3K views1 page

Credit or Debit Card Authorisation Form

This document provides instructions for paying registration transfer fees by credit or debit card. It states that the cardholder authorizes VicRoads to charge the card for the transfer fee plus a card payment fee. The cardholder is responsible for ensuring their card details are correct and there are sufficient funds to cover the payment within 14 days. If the payment fails, VicRoads will notify the cardholder and give them 7 days to provide an alternative payment before taking action like suspending the registration.

Uploaded by

Salam
Copyright
© © All Rights Reserved
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
  • Credit or Debit Card Authorisation: The section provides detailed instructions and fields required for authorizing credit or debit card payment for vehicle registration transfer, including cardholder and vehicle details.

Credit or debit card authorisation

This form must be completed (by the buyer) and returned with the Application for transfer of registration form if the application is
lodged by mail and the payment method is credit or debit card.
Important: terms for credit card use
Vehicle details
• As the cardholder I acknowledge and accept that a card payment fee will
Registration number of the vehicle being transferred apply to the transaction, and that details of the fee are available at
vicroads.vic.gov.au
By signing this form I authorise VicRoads to deduct the card payment fee in
addition to any amounts payable.
Credit or debit card authorisation • VicRoads will arrange for funds to be debited from your nominated credit or
debit card as authorised by you within fourteen (14) days of your form
If paying by credit or debit card, please provide your card details and your submission.
authorisation for card payment here. • It is your responsibility to ensure that you have sufficient credit available on
Note: A card payment fee will apply when using Mastercard or Visa. your credit or debit card within fourteen (14) days of submitting your form to
For further information refer to vicroads.vic.gov.au cover your payment and that your card details are current and correct.
For correct processing, please print clearly in ink using BLOCK letters. • Should your credit or debit card payment default, VicRoads will notify you
immediately and allow seven (7) days for you to respond with alternative
Card type payment.
Visa Mastercard • If your declared payable amount is insufficient, VicRoads will notify you
Credit or debit card no. immediately and allow seven (7) days for you to pay the balance outstanding.
• Should a response not be received within the seven (7) days allowed
VicRoads may take action to suspend your registration.
Date of expiry (mm/yy) • If you believe that there has been an error in debiting your credit or debit card
you should notify us immediately on 13 11 71 so that we can resolve your
/ query promptly.
Name of cardholder

Total payable amount


$
Cardholder signature
Date (dd/mm/yyyy)
/ /

Lodge this completed form with the Application for transfer of registration form, to:
GPO Box 1644
Melbourne Vic 3000

PTVH5190 VRPIN02980 08.20 Authorised and published by VicRoads, 60 Denmark Street, Kew, Victoria, 3101.

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Page 1 of 1 Credit or debit card authorisation PTVH5190 VRPIN02980 08.20 Authorised and published by VicRoads, 60 Denmark

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