REGISTRATION FORM
REGISTRATION FORM
Name: (include initials & nick-names) ……………………………………………………………………………………………
Current address: ………………………………………………………………………………………………………………………………
Current phone No: …………………………
………………………………Mobile……………………………………………………
E-mail address: …………………………………………………………………………………………………………………………………
Name: (include initials & nick-names) …………………………………………………………………………………………
Current address: …………………………………………………………………………………………………………………………
Current phone No: …………………………
………………………………Mobile…………………………………………………
E-mail address: ………………………………………………………………………………………………………………………………
Vehicle registration::………………………………………………………………………………………………………………………
Vehicle make, model & colour:…………………………………………………………………………………………………………
Trailer registration No.:……………………………………………………………………………………………………………………
Intended departure date:……………………………………………………………………………………………………………
Please complete the required option:
| 3 months regisistration (minimum) -A$22.00 per month/per Name | |
| (Payable in advance) | A$ |
| 6 months registration - A$22.00 per month/per Name | |
| (Payable in advance) | A$ |
| 12 months registration - A$22.00 per month/per Name | |
| (Payable in advance) | A$ |
| A$50.00 advance postage deposit | A$ |
| -------------- | |
| subtotal | A$ |
| Less applicable discount | |
| For 6 months: Pay just 5 months, discount A$22,- | |
| For 12 months: Pay 10 months for first year, discount A$44,- | |
| -------------- | |
| TOTAL AMOUNT ENCLOSED | A$ |
I have read and understand the terms and conditions of Post Haste
Australia
Date:
Signed: …………………………………………………………………