The Australian Pony Stud Book Society Inc.
ABN: 18 280 213 644 PO Box 57, Geebung, Qld 4034 ph: 07 3216 2011 fax: 07 3216 2509 e-mail: registrar@apsb.asn.au
LEASE TERMINATION
To be completed on termination of an indefinite lease or early termination of a defined period lease. PLEASE PRINT IN BLOCK LETTERS - DO NOT USE CORRECTION FLUID Pony Details: Reg.No: Date of Birth: / / Prefix: Brands - Near Shoulder: Name: Off Shoulder:
Leased From (owner): Member No: Address: Name:
Leased To (lessee): Member No: Address: Name:
Period of Lease:
From
/
/
To
/
/
(leave end date blank for indefinite lease)
The lessor and lessee hereby certify that the pony, detailed above, was returned by the lessee to the owner on / / (date of return). Date: Date: / / / /
Owner’s Signature: Lessee’s Signature:
FEE PAYMENT DETAILS: Enclosed is a cheque / money order made payable to APSB for: $ Or charge my credit card: Mastercard Visa Bankcard
Expires: Signature:
/
Name on Card: Receipt Required
CARD CHECK VALUE
(3 digit no. on back of card)
refer to website (www.apsb.asn.au), your State Branch Secretary or the Registrar for latest fee schedule
April 2005