CLIENT DETAILS Organisation ABN Contact Person Telephone Email Invoicing Address Certificate Address COURSE DETAILS Course Course Dates Start & Finish Time Course Location Price Per Person or Total Per Day Participants Name D.O.B USI Number Participants Name D.O.B USI Number 1. 6. 2. 7. 3. 8. 4. 9. 5. 10. PAYMENT OPTIONS ***All payments must be made prior to course commencement *** Purchase Order No for existing account holders only – (Copy to be Supplied) Deposit amount is to be paid on enrolment and you will be provided with a Payment Scheduled - conditions apply payment schedule to authorise payments with a valid credit card / / / VISA Expiry: / CVV #: (last 3 digits on back of card) Credit Card Card Holder Signature: MasterCard Direct Deposit/EFT for prepayment only Account Name: Pegasus Management Pty Ltd – (Please forward remittance) BSB NO: 082-845 A/C NO: 53 007 3530
CLIENT DETAILS Organisation ABN Contact Person Telephone Email Invoicing Address Certificate Address COURSE DETAILS Course Course Dates Start & Finish Time Course Location Price Per Person or Per Day Total Participants Name D.O.B USI Number Participants Name D.O.B USI Number 1. 6. 2. 7. 3. 8. 4. 9. 5. 10. PAYMENT OPTIONS ***All payments must be made prior to course commencement *** Purchase Order No – for existing account holders only (Copy to be Supplied) Payment Scheduled - conditions apply Deposit amount is to be paid on enrolment and you will be provided with a payment schedule to authorise payments with a valid credit card Credit Card VISA / / / Expiry: / CVV #: (last 3 digits on back of card) Card Holder Signature: MasterCard Direct Deposit/EFT – for prepayment only (Please forward remittance) Account Name: Pegasus Management Pty Ltd BSB NO: 082-845 A/C NO: 53 007 3530
FOR-Course-Booking-Form.docx