Fee Collection Form

Fee Collection Form
Section 1: Student Information
Student ID
Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Email Address
example@example.com
Mobile Number
Format: +61 000-000-000.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Course/Program Name
Section 2 – Payment
Payment Method
For Bank Transfer:

Please make deposit to CITI account as below:

Account name: EV higher

BSB No: 067 873

Account number: 2040 0910

(Please add your name or student ID on remark)

Email accounts@citi.nsw.edu.au for payment receipt or ask for other payment method

Payment Amount

AUDDescription

Debit or Credit Card
Credit Card Number	Security Code
Expiration Month	Expiration Year

1