Payment Advice Membership

Beenleigh.biz Membership Application

Beenleigh.biz is a wholly owned division of SupplyLink International Pty Ltd (ABN 16 067 381 702).

Simply print the form below, complete and post to us with the applicable payment. We will advise you of your Membership Details within 48 hours of receipt.
Membership of Beenleigh.biz entitles the member to the benefits detailed in the Membership area of this site.

Name:

__________________________________

Date:

______/________/________

Business Name:

__________________________________

Street Address:

__________________________________
__________________________________

Street Suburb:

__________________________________

Postcode:

__________________________________

Phone:

__________________________________

Mobile: (if applicable)

__________________________________

Fax: (if applicable)

__________________________________

e-mail:

Web site:

Categories of interest:

Directory;

Classifieds;

Shopper;

Monthly Specials;

Coupons;

Web Hosting;

Web Design;

Cost Management

Other:________________________________

Buyer Membership:

FREE with Directory Listing

Buyer Membership:

$95 p.a. without Directory Listing

Supplier Membership:

$195 p.a.

Payment method:

Cheque

Money Order

Read and Agree to the Terms & Conditions

Yes

Payment by Cheque or Money Order

I have enclosed a cheque for $___________

Please make cheques payable to SupplyLink International Pty Ltd and write your domain name or invoice number on the back of your cheque. Mail your payment, together with this form and the printed order form the address at the bottom of this page.

Payment by Credit Card

Type of card:	Bankcard MasterCard VISA
Name on card:	_________________________________
Card number:
Expiry date:	______/________/________
Cardholder signature:	__________________________________

Please mail this form to:
SupplyLink International Pty Ltd
PO Box 313
Beenleigh Qld Australia 4207

THANKYOU for your payment