COMPANY NAME: TRADING AS: TRADING ADDRESS: SUBURB / TOWN: STATE: POSTCODE: TELEPHONE: FAX EMAIL: INTERNET: SOLE TRADER / PARTNERSHIP / TRUST / COMPANY ABN: NAMES AND ADDRESSES OF PROPRIETORS / PARTNERS / DIRECTORS: NAME 1: ADDRESS: NAME 2: ADDRESS: NEW BUSINESS: YES / NO PERIOD OF TRADING: YEARS. PREFERRED PAYMENT METHOD (Please Tick) ( ) EFT TO Compass Media Entertainment BSB: 012-559 ACCOUNT NO: 207414905.
PLEASE FAX/EMAIL REMITTANCE ADVICE. PLEASE USE OUR INVOICE # AS YOUR PAYMENT REFERENCE. ( ) Cheque/Money Order – to be posted to PO Box 10, Camden NSW 2570. Goods will not be released until
Payment is cleared. ( ) Credit Card (We accept Visa and MasterCard Only)
Please tick if you want the above Credit Card Details kept on File and used automatically to pay for your orders and fill out the Card Details below:
Card Type: _____________ Card No. ______________________________________ Expiry Date ____/____ I/we agree that I/we will abide by Compass Media Entertainment Conditions of Trading at all times. Signed for and on behalf of