University Of Cambridge
Department Details
Department name:
Faculty of English
Department Address:
9 West Road, CAMBRIDGE, CB2 3DP
Department Contact:
Mrs Heidi Hume
Department Tel:
01223 335197
Cardholder’s Details
Cardholder Name………………………………………………………………………………..
Cardholder’s address (address to where credit card statements are sent)
……………………………………………………………………………………………………………
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Postal/Zip code………………………
Contact telephone number…………………………………………………………….
Email address in case of any queries ………………………………………………..
CREDIT/DEBIT CARD DETAILS
MasterCard

Visa 
Start date:
/
End date:
/
Issue number:
Switch 
Maestro 
Solo 
Electron 
(for Switch, Solo and Maestro only)
Card Number:
Security Number (last 3 digits on reverse of card):
Total Amount to be Debited:
£ _______________
I hereby authorise that the card account specified may be debited with the amount stated above.
Cardholder’s Signature…………………………………….
Date:
……………………….............
Refer to booking form website for refund policy
For Official Use Only:
Description Of product/service: UNCERTAIN KNOWLEDGE – CONFERENCE APRIL 2011
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GL Distribution Code/Invoice number
GG.GGCE.GAAA.
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