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| CREDIT CARD PAYMENT AUTHORITY | ||||||||||||||||||||||||
| To QUINN-healthcare, I authorise you until further notice in writing, to charge my credit card account, unspecified amount in respect of subscriptions for QUINN-healthcare membership as and when these become due, until the instruction is countermanded by my giving notice to QUINN-healthcare. | ||||||||||||||||||||||||
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| Mastercard/Access | Visa | |||||||||||||||||||||||
| If you wish to pay by credit card for this year only please tick the box. This will end the mandate after the payment has been made. |
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| You will be given one month's notice of any subscription increase. | ||||||||||||||||||||||||
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| Please insert your appropriate credit card number: | ||||||||||||||||||||||||
| Expiry Date: |
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| QUINN-healthcare membership number. | ||||||||||||||||||||||||
Your insurance is provided by Quinn Insurance Limited. Quinn Insurance Limited (trading as Quinn Healthcare) is regulated by the financial regulator.
