Organisation / School Name*

Organisation / School Address*

Address Line 2

Suburb / Town*

State* Select... QLD NSW VIC ACT TAS SA WA NT

Post code*

Phone*

Fax*

Postal Address

Postal Address Line 2

Suburb / Town

State Select... QLD NSW VIC ACT TAS SA WA NT

Post code

First Name*

Last Name*

Position*

Mobile*

Phone(Work)*

Phone(AH)*

Email address*

First Name*

Last Name*

Position*

Mobile*

Phone(Work)*

Phone(AH)*

Email address*

There is a set-up charge of $50(excl. GST) for new 'Graduation Gift' Customers. Are you a new or existing customer?* Select... New Customer Existing Customer

We will credit you $10 if you have previously received a sample item and were charged $10 per item. Did you previously pay $10 for a sample?* Select... Yes No

Date Required* Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month January February March April May June July August September October November December Year 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036 2037 2038 2039 2040 2041 2042 2043 2044 2045 2046 2047 2048 2049 2050 2051 2052 2053 2054 2055 2056 2057 2058 2059 2060 2061 2062 2063 2064 2065 2066 2067 2068 2069 2070 2071 2072 2073 2074 2075 2076 2077 2078 2079 2080 2081 2082 2083 2084 2085 2086 2087 2088 2089 2090 2091 2092 2093 2094 2095 2096 2097 2098 2099

If you would like to include a logo or emblem on your pen, please email your artwork to robert@australianfundraising.com.au.* Select... Yes No

If you would like to include individual student names on your pen, please email an excel file including the data to robert@australianfundraising.com.au.* Select... Yes No

Organised By* Select... School P+C / P+F Club Other

How did you hear about us? Select... Internet search Fundraising Directory Magazine Fundraising Directory Website Received Catalogue in the Mail Purchased Product Trade Show Word of mouth Yellow Pages Google paid ad Other

Would you like to join our mailing list? Select... Yes No

Terms & Conditions of Sale: By placing this booking you have agreed to purchase items with BLC International P/L trading as Australian School & Club Fundraising Specialists™. On receipt of your order, we, you or your organisation above the total cost stated below. Payment is required within 7 days of despatch of goods (to approved customers only). I warrant that I have the authority to order the below product/s behalf of the stated group above. I warrant that I have read the terms and conditions of sale. I am over the age of 18 years of age and I understand and agree to uphold the terms and conditions. I understand legally binding contract between myself and BLC International P/L trading as Australian School & Club Fundraising Specialists™. I also agree that I am responsible for the payment to BLC International P/L Australian School and Club Fundraising Specialists™. Ownership of the goods does not pass until the invoice is paid. OUR PAYMENT TERMS ARE 7 DAYS FROM DESPATCH OF ITEMS.

I have read and accept the Terms & Conditions of Sale* Select... Yes