h18726 s 00003/00000/00090 d D 1.3 99/09/28 12:54:13 andrew 3 2 c Clarify card number e s 00037/00000/00053 d D 1.2 99/09/13 19:37:10 andrew 2 1 c Incorporating feedback from dept e s 00053/00000/00000 d D 1.1 99/08/31 19:57:12 andrew 1 0 c date and time created 99/08/31 19:57:12 by andrew e u U f e 0 t T I 1

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

I 2

Credit/Debit card

Card Number:
I 3 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.
E 3 Account name:
Expiry Date:
Issue Number (if any):
E 2

Applicant will pay by post

I 2 E 2

Applicant has paid today

Amount paid:
I 2

Cancel application

E 2 E 1