This form can be used for providing payment by credit card or debit card for an existing website, e-mail or phone order.

Card Holder Information

Payment Authorisation

*IMPORTANT: Customers are required to attach a scan or photograph of your credit card (front) and driver's license (front) to verify your signature and identification. We will not be able to process your payment without this.*

*Personal information collected from you is held and used by Global Fitness and Leisure Pty Ltd under the provisions of the Privacy andPersonal information Proection Act 1998

The supply of information is voluntary, however if you cannot provide, or do not wish to provide the information sought, Global Fitness and Leisure Pty Ltd may be unable to process your request.

Please note: Global Fitness and Leisure Pty Ltd will not keep a file of your credit card details. At the completion of the transaction, this form will be discarded and any records will destroyed.