We recommend that you print this Payment Form before completing in blue or black ink.
You may also complete the form electronically before printing. The final section of the form must however be completed by hand.
Parent/Guardian Details
The adult responsible for the booking must complete the details in this section. All correspondence will be sent to the address provided here.
Title
First Name
Surname
Address
Postcode
Country
Note: The address must match the credit card company's records to enable us to obtain authority to debit your account.
Telephone (Day)
Telephone (Evening)
Email Address
Please provide a valid e-mail address so we may confirm receipt of your Payment Form.
Payment Information • We accept Switch, Delta, Mastercard, American Express, Visa and Diners Card • Payment may also be made by Cheque (made payable to Lorrin Golf Trust Account).
Preferred method of payment (please tick)
Credit Card Debit Card Cheque
Card Details
Name as it appears on card
Card Number
Type of Card
Expiry Date
/ (Month / Year)
Issue Number
Security Code
(the last 3 digits on the reverse of the card)
Deposit (or full payment if appropriate) £195/£390 per junior (see booking form for details)
£
LG Insurance Cover £20 per Academy £30 for two consecutive academies
£
Insurance Details Please print this Payment Form before leaving the page as information already input may be lost.
Airport & Rail Pickup £20 standard charge
£
Total Paid
£
Second and Final Payment should be made before 29th April 2008.
Please tick this box to confirm you have read, understood, and accept Lorrin Golf's booking Terms and Conditions.
Please print this Payment Form before leaving the page as information already input may be lost.
Academy Booking as it appears on the Booking Form (please tick)
No. of Golfers
This section must be completed by hand. Click here to print the form and complete it.