Entrepreneur Sales – Berchel Pty Ltd
Credit Card Authorisation FAX TO: +61 (0)7 55 202 015
First Name: __________________________ Surname:__________________
Address: ______________________________________________________
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Email:_______________________________ Mobile Phone:_____________
Real Estate Sales Business in a Box: $570.00 (Plus GST) $627.00
Includes Marketing Materials, Action Planner, & Bonuses
(Over $1,500 worth in value)
You can cancel you coaching at any time
Postage and Handling $25.00
TOTAL: ________
Credit Card Details
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Card Type Visa Master Card
Expire date: ______/______ Name on card: ____________________________________
Credit Card Verification number (last 3 digits found on back of credit card) __ __ __
Postal address for Credit Card if different to above: (this is for security only)
_______________________________________________________________________
________________________________________________________________________
By completing this credit card authorization, I hereby authorize the debit of my credit card for the amount stated on this form. By signing below, I confirm the information above is true and correct.
___________________________________________________________ _____________________________
Customer Signature Date