CREDIT CARD PAYMENT FORM

Institution of Mechanical
Engineers
1 Birdcage Walk
Westminster
London SW1H 9JJ
For help:
UK Telephone: 0845 2269191
International: +44(0)20 73046999
Email: membership@imeche.org

By signing this form I authorise the Institution of Mechanical Engineers to debt the above charge to my credit /
debit card for the payment of fees indicated above. I also understand that the payment is non-refundable and
non-transferable. All information is treated as confidential and used for payment of application fees only.
Please refer to the FEES section of our website
before completing this form to confirm the
appropriate application fee

Contact Details

Surname

First name

IMechE Membership

Date of birth

Telephone number

If you do not wish to include your card details on this form and would prefer for us to
contact you to take payment over the telephone, please tick the box ad fill in the contact
details above

Application fee (tick as applicable)

30 CLA application fee 100 Application fee

40 Application fee 110 Application fee

40 Re-application fee 165 Application fee

75 Application fee 190 Application fee

Credit Card / Debit Card details (please note we do not accept American Express)

Card Type Visa MasterCard Maestro

Name as it appears in card

Billing address

Card number

Expiry Date

Maestro Only: Issue number or valid from date

By signing this form I authorise the Institution of Mechanical Engineers to debt the above charge to my credit /
debit card for the payment of fees indicated above. I also understand that the payment is non-refundable and non-
transferable. All information is treated as confidential and used for payment of application fees only.
Cardholder Signature

Date

By signing this form I authorise the Institution of Mechanical Engineers to debt the above charge to my credit /
debit card for the payment of fees indicated above. I also understand that the payment is non-refundable and non-
transferable. All information is treated as confidential and used for payment of application fees only.