Secure Online Credit Card Payment Facility
Please complete all fields on this form
Your First Name
Street
Your Last Name
Suburb
Post Code / ZIP
City
State / Province / Region
Country
- Select a country -
American Samoa
Australia
Austria
Belgium
Canada
Chile
Denmark
Fiji
Finland
France
Germany
Greece
Guam
Hong Kong
Iceland
India
Ireland
Israel
Italy
Japan
Korea, South
Luxembourg
Malaysia
Mexico
The Netherlands
New Zealand
Norway
Poland
Portugal
Puerto Rico
Singapore
Spain
Sweden
Switzerland
Taiwan
Thailand
Turkey
United Kingdom
United States of America
Virgin Islands
Credit Card Type
Mastercard
Visa
American Express
Card Number
3 or 4-digit CVV
Your Business Name
Name on Card
Lithium Invoice Number(s)
Card Expiry Date (mm/yyyy)
Month
01
02
03
04
05
06
07
08
09
10
11
12
Year
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
Total Amount
including
GST (
in Australian $
)
Your e-mail address (an electronic receipt will be sent to this address)
By clicking the "
ACCEPT
" button below, I authorise Lithium Solutions Pty Ltd to charge my Credit Card in accordance with the services I have requested and agreed to pay for.
To confirm that you have acknowledged this statement
, please type
YES
in this box: