MEMBERSHIP No _____________________

ADDRESS______________________________________________________________

_____________________________________________________P/C_____________

PHONE______________FAX_______________Email___________________________

CARDS REQUESTED: Minimum purchase is $11.00 (inc GST) for each 5 cards. No of Cards
(lots of 5) ________ Total Amount $________

PAYMENT DETAILS:
CHEQUE/MONEY ORDER ENCLOSED $____________

CREDIT CARD HANDLING FEE
Please note that there is a $6.60 (inc.GST) or 4% (+GST) service fee whichever is the greater, on all credit card transactions.

CREDIT CARD DETAILS:

TYPE OF CARD_______________AMOUNT $___________EXPIRY DATE______/______

NAME ON CARD_________________________________________________________

C/ CARD No ___ ___ ___ ___ / ___ ___ ___ ___ / ___ ___ ___ ___ / ___ ___ ___ ___

Declaration
I agree to all the terms and conditions that apply to the use of the Clubmate card and agree that these terms and conditions are not limited to those listed below:
i. If my membership to Perth Social Times ceases then access to Perth Social Times services also ceases through the Clubmate card.
ii. All cards remain the property of Perth Social Times.
iii. Perth Social Times will not be held responsible or accountable for any services offered by its agents or advertisers.
iv. Any cards I receive for distribution does not make me an agent or an employee, nor does it place any employment relationship of any kind on Perth Social Times.
v. I agree that offers can change without notice and will not hold Perth Social Times responsible or accountable for any such changes.
vi. I have kept a copy of this application for my reference.
vii. I understand that Cash Credit accounts are published every fiscal quarter.
viii. I agree to have the monthly account service fee deducted from my account. I understand that the fee is 10% of my cash deposit but not exceeding $5.50 (inc GST) per month whichever is the lesser.
ix. I agree that the service fee applies to each lot of five Clubmate cards attached to my Perth Social Times membership.
x. I agree that cash withdrawals can only be made once every fiscal quarter after publication of account balances.
xi. Clubmate cards are valid for 12 months from date of purchase.
xii. Each order must be a minimum of five Clubmate cards.

Signed ________________________________________________Date____________________

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