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Company
Name ______________________________
Summit Package
requested ________________________
Sponsorship Investment:
AUD$___________
Contact
Person ____________________ Position
_______________________
Contact
Telephone numbers business________________
mobile_________________
Email
address ___________________________
Payment
option (tick one) EFT ________ Cheque ________
Credit Card _________
Electronic
Funds Transfer
Please deposit funds into the following bank account and fax this
form to +61 3 9646 322
Bank NAB
Address
330 Collins
Street, Melbourne, Victoria, 3000.
Name of account CoreNet
Global
BSB
083 749
Account number 569
573 022
Cheque
Please send a copy of this form and your Cheque to:
CoreNet Global
PO Box 5044
Garden City VIC 3207
Credit
Card
Please
note: Payment by credit card will attract a surcharge of 2% for
Mastercard and Visa or 4% for American Express
Payment
Authorisation:
Sponsorship amount AUD $
_____________ plus 2%_____________OR plus 4%
______________ Total $ ______________
Please
charge the total to my
card:
VISA
MasterCard
American
Express
Name as it
appears on card ……………………………………………………………………...
Credit
Card number.
……………………………………………………….
Expiry Date: …….../………
Signature
of card holder …………………………………………………………………………………………
Please fax
your authorisation to +61 3 9646 3222
For
further information please contact Peter Chenoweth - Region
Director on:
+61 3 9646
9703
+61 3 9646
3222
CoreNet
Global
P.O. Box 5044
Garden City VIC 3207
Australia | 