Embassy of Australia

United States of America

Embassy address: 1601 Massachusetts Ave, NW Washington DC 20036 - Telephone: (202) 797 3000 - Fax: (202) 797 3168

Credit Card Authorization

Use this form only for payments in Washington only.

Please print this form, complete it with clearly written block letters, sign it, and return it with your documents or fax it to +1 202 797 3331.

Check type of card

Visa:

Mastercard:

Card number

Expires

Name exactly as it appears on the card

Billing address for this card

Check items to charge

Consular Fees

Airfares

Courier Fee

Write amount to charge

USD

Signature

I agree to pay for the goods and/or services indicated and agree to perform the obligations set forth in my agreement with the card issuer.