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PAYMENT BY CREDIT/DEBIT CARD

MSc/Diploma independent distance learning courses/exams


School of Energy, Geoscience, Infrastructure & Society

STUDENT DETAILS
Heriot-Watt  THIS MUST BE COMPLETED
Person/Student ID: (Hxxxxxxxx or 9 digits)
Title (Mr/Miss/Mrs/Ms):
SURNAME OR
FAMILY NAME: FIRST NAME:
Correspondence
Address:

Country: Postcode/Zip:

Telephone number: Email:


Programme
Programme code: title:

CREDIT/DEBIT CARD PAYMENT DETAILS (* mandatory fields must be completed)

PAYMENT FOR (Tuition/course fees paid by


(PLEASE TICK credit/debit card must be EXAMINATION FEE:
APPROPRIATE BOX): paid online.)

When paying by credit card, a surcharge of 1.75% must be added to the payment. This is the cost of
processing to the University.

I am paying by * :
Credit card Switch Other Debit Card
(surcharge applies) (surcharge charge does NOT apply) (surcharge does NOT apply)
Switch Issue No:
Payment: £ . *
Please indicate if you wish to be charged in
Surcharge (1.75%): £ . * local currency

Total charge: £ . * Please indicate if you wish a receipt

* *
Name of Card Holder Date Issued
*
Card Number For Switch only Expiry Date
Security Code (last 3 digits on strip on back of card): *

Card Holder’s Signature: _____________________________* Date: ____________________


Please return this form to: Student Support Team, at egis-idl-enquiries@hw.ac.uk OR School of Energy, Geoscience,
Infrastructure & Society, Heriot-Watt University, Edwin Chadwick Building, Edinburgh Campus, EDINBURGH, EH14 4AS, UK