Tables and Chairs Licence Application Pack - Islington Council

TABLE AND CHAIRS APPLICATION PACK
Tables and Chairs Credit Card Payment details
You may pay for a Licence with your credit or debit card, please give your details below.
I wish to pay by Credit / Debit Card
Please delete as appropriate Visa / MasterCard / Delta / Switch / Maestro
WE DO NOT ACCEPT AMERICAN EXPRESS CARDS
Credit / Debit Card Number:
_______
Expiry Date: ___start date: _______
Delta / switch / Maestro users only: Issue Number: __________________
Security Code ______________________ (The last three digits from the signature strip)
Name of cardholder:
Address: of cardholder
____________
______
___________________________________________________________
_ Postcode:
____________
Telephone/Mobile Numbers:
Name and address of premises on application __________________________________
_______________________________________________________________________
Please debit the above card to the sum of
Fee £
The signatory below is the person accepting responsibility for the compliance of all conditions
of the attached licence application
Signature of Cardholder:
______
Print:
Date:
______________________________________________________
_____________________________________
Please ensure that the form is fully completed. Should the credit / debit card be declined for any
reason, then a cheque will be required and this may delay the processing of your licence.
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