Loyalty Group Application

Use this form to apply to register your group to be set up to recieve a volume based discount. This is great for fleet vehicles, car or enthusiast clubs. Clubs or groups must have atleast a minimum of 20 members or in order to be qualify. Submit this form and we will respond as quickly as possible.

Contact Name

Organisation name

Address Details

Physical Address

Suburb/Town

Postal Code

Postal Address

As above

Send to Address Above

Address / PO Box

Suburb/Town

Postal Code

Contact Details

Contact Phone

Fax

Mobile

Email Address

We will send our offers to this emaiil address

Organisation details

How many in your group or organisation?

So we know how many cards to send

Please provide your official organisation details below. This will be used for sending things direct to the organisation include commission cheques.

Official Name

Secretary Name

Address

Town/City

Postal Code

Notes

Enter the code

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Loyalty Group Application

Address Details

Postal Address

Contact Details

Organisation details

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