Interstate™ Batteries

Booking form for Interstate™ Batteries

* Most fields are required to completely process your booking form.

A copy of this order will be emailed to the co-ordinators email address below.

PLEASE ENTER YOUR ORGANISATION / SCHOOL DETAILS
Organisation / School Name*
Organisation / School Address*
Address Line 2
City*	State*	Postcode*
Postal Address (if different)
City	State	Post Code
CO-ORDINATOR DETAILS (Must be at least 18 years old)
First Name*	Last Name*	Title of Co-ordinator*
Day Phone*	Evening Phone	Mobile*
Facsimile*	Email address*
Treasurer's Name*		Treasurer's Phone Number*

FUNDRAISING PROGRAM DETAILS
Number of Participants (No. of brochures to be sent)*
Date you Require Battery Order Forms to be delivered to you
Day*	Month*	Year*
Event organised by*
Date Battery Order Forms to be sent home by you
Day*	Month*	Year*
Final Date for Return of Battery Order Forms and monies to you
Day*	Month*	Year*
Delivery Address*
TERMS & CONDITIONS OF SALE INTERSTATE™ BATTERIES FUNDRAISING PROGRAM: PAYMENT IS REQUIRED PRIOR TO DELIVERY By placing this booking you have agreed to conduct an Interstate™ Batteries fundraising program with BLC International Pty Ltd trading as Australian School & Club Fundraising Specialists™ and Interstate™ Batteries. Payment has to be made prior to delivery. This order is made in accordance with the terms and conditions above. I warrant that I have the authority to order the above fundraising program on behalf of the stated group. I warrant that I have read the above conditions of sale.
I HAVE READ THE TERMS & CONDITIONS OF SALE*
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*Required