TOASTMASTER NAME BADGES - DOC

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                                               TOASTMASTER NAME BADGES
                                                                                 ORDER FORM
* Date of Order ………………………………..

* Club Name :………………………………………………………………. *Club No…………………………...*District ………...
*Postal Address…………………………………….....................................                                     *Contact Name…………………………….……..
… …………………………………………….…………………*Post Code ……..                                                                 *Contact Phone Number……………………
                                                 Please complete the lines marked with this sign *
                  (Please PRINT Clearly in BLOCK letters – we will not be responsible for spelling
                                            errors made because we could not read the writing)
                 Badges required                                                                          NOTE Charter Member = Founding Member
                                                                                                                                            Charter         Badge
 First       Name                                         Surname                                                       TM Rank             Member          Option
                                                                                                                                             Y/N          (A,B or C)




 Payment details - Make Cheque or Money Order payable to                                         PAYMENT METHOD – Please Circle
                    “Toastmasters District 69”                                                   Cheque Money Order Direct Deposit                     Credit Card
 And mail to:   District 69 Badge Coordinator
                                                                                                 BADGE COSTS
               149 Anzac Avenue                                                                  Option A Standard Badge (with Pin)                          $ 8.00
               REDCLIFFE QLD 4020
 Email: barrier1@optusnet.com.au      Phone 07 32832903                                                    B Plastic Alligator Clip (with Safety Pin ) $ 8.50
                                      Fax 07 38856863                                                      C Magnetic Badge Clip (no Pins)                  $10.00
       Please post order with Cheque or Money Order to:
 Or pay on Line using Club Name as the payment reference
 BSB 633-000 ACC NO 133525774 B F RICHARDSON                                                    Badges Option             A ….          @       $8.00$….….…..
 Or pay by Credit card and give details below :                                                                           B ….          @       $8.50$...............
                                                                                                                          C ….          @      $10.00$...............
 Charge my:        Mastercard                             Visa         No American Express      Executive Badges
         ef 2/10                                                                                PRES VPE VPM VPPR SEC TRE SAA
 Credit Card
                                                                                                (Circle which ones required above)…..   @        $4.00$...............
 Number:      -- -- -- --     -- -- -- --   -- -- -- --    -- -- -- -- CVV No.       -- -- --
                                 Last 3 numbers on back of Card                                 Executive Badges Full Set @     $26.00$...............
      Your payment can not be processed without this CVV number                                 Postage & Pack up to 4 badges $3.00$ …..……..
 Cardholder’s Name:………………………………………………………                                                                         5 to 8 badges $5.00$ ...............
                                                                                                                        SUB TOTAL $………….
 Amount authorised: $............................ Expiry date                    /              Credit Card Fee 4% of Sub Total       $...............
                                                                                                (This fee will be charged if not included)
 Cardholder’s Signature:……………………………………………                                                                                                   TOTAL       $...............
 If you are paying by Credit Card there is a 4% Fee to be added to cost of this
 order. To calculate this fee please multiply the total amount by 4% and add to the total.                Badges will not be posted if postage
 If there a calculation error we will adjust it when processing the payment.                                  is not included with order.