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Collapse panel Make a payment by credit card
  OurRef is located in bold in the subject line of our letter.
Also on the top right hand corner of the reverse of our letter. 
Cardholder Name     
  Please enter your name as it appears on your credit card. 
Card Number     
  The 16 digit number that appears on the front of your card. 
Expiry Date   Month Year    CSV 
Payment Amount
  NB. Payment by credit / debit card will attract a variable merchant fee which will be displayed here
once your card number is entered. This fee is the cost of acceptance charged to us by our
merchant facility provider. By proceeding with this transaction you hereby acknowledge and
accept that this fee will be added to the payment amount above.  Minimum payment is $20
Merchant Fee
Amount after fees
  This field can be used to convey any pertinent message to ADR staff
in relation to your account.
Email To Receive Receipt   

I hereby authorise the Merchant to debit my Card Account accordingly.
Please only press Proceed once as the Payment Amount will be processed once for each press.
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