Payment for network service

Please ask the applicant to check these details:

Applicant
Username
Hall
Flat number
Room
Outlet
Start date
End date
Connection fee£
Semester fee£

Total cost: £


Payment

Credit/Debit card

Card Number:
NOTE: This is the large number printed across the middle of the card (usually 16 digits). Please put spaces in just as they appear on your card.
Account name:
Expiry Date:
Issue Number (if any):

Applicant will pay by post

Applicant has paid today

Amount paid:

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