Paying In Charity Money

Pudsey

Please only use this form if you wish to pay your charity monies in using Debit or Credit Card.

If paying by cheque please send by post along with your sponsor form.

Thank You.


* indicates required fields 
  *Participant Number::
  *Your Full Name::
  *Your Full Address::
  *Your Postcode::
  Telephone (Home)::
  Telephone (Mobile)::
  Telephone (Work)::
  *Email Address::
  *Paying By Credit / Debit Card::
  *Card Type::
  *Long Card Number::
  Valid From Date: (MM/YY):
  *Valid To Date: (MM/YY)::
  *Card Security No. (3 Digits)::
  Card Number (Switch/Solo Only):
  *Name on Card:
  *Amount to be Debited £:
  *Confirm Amount to be Debited £:
  *Electronic Signature:  Authorise SRA to debit my Card

Thank You for submitting your Sponsor Money.

Your details are now being encrypted to 128bit security and forwarded to Southern Rock Adventures Offices.

Thank You once again and hope to see you next year.
   
 

We accept PayPal Payments for all of our online bookings using any of the Credit/Debit Card listed below. All payments are 100% secure using 128bit Encryption.

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Registered in England & Wales, Registered Office: 31-33 Penel Orlieu, Bridgwater, Somerset, England UK, TA6 3PF
All information contained on this web site is purely information only as can not be used as pure fact.
SRA are the sole holders of the copyrights.
 
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