CARD APPLICATION FORM - Repco Trade Zone
CARD APPLICATION FORM - Repco Trade Zone CARD APPLICATION FORM - Repco Trade Zone
CARD APPLICATION FORMPlease complete all fields to insure the prompt issuance of your Card. Please lodge your application at your local Repco Store for approval.* Mandatory fieldsCONTACT DETAILSBusiness Name:ABN:* Title: Mr. Mrs. Miss Ms* First Name:* Surname: Birth date:/ /* Please enter at least one contact phone numberWork Telephone No. Mobile No. Home Telephone No( ) ( )* PREMISES ADDRESS: POSTAL ADDRES: Tick here if same as Premises Address* Street Address: Street Address:* Suburb: * State: * Postcode: Suburb: State: Postcode:Email Address: (use block letters)I prefer to be contacted by: (please check all that apply) Email SMS Mail* I am best described as: (please check one box)GENERAL INFORMATION* How much would you expect to spend per month?(please check one box) General Motorist Do It Yourselfer Between $150 and $500 Between $501 and $1500 Serious Car Enthusiast Automotive Trade Professional More than $1500* How often would you visit a Repco Store: (please check one box) Weekly Fortnightly Monthly Yearly Never* Do you own a business / What type of business do you have? (please check the one box that best describes your business) No Business (move to nextsection) Agricultural Machinery Air Conditioning Steering & Suspension Diesel Mechanic Car Dealership Auto Electrician Wrecking Yard General Automotive Panel Beater Exhaust Specialist Service Station Towing Mobile Mechanic Radiator Specialist Brake/Clutch Specialist 4WD Specialist Marine Mechanical Tyres EFI Diagnostics Gas Conversion Truck Specialist Carburettor Specialist Engine Reconditioner Motorcycle Specialist OtherTell us a little bit about you? (please check all applicable boxes)PROFILE INFORMATION I regard my car simply as transportation I am passionate about cars I am into motor sports I take motoring holidays I own a motorbike I own a 4WD I take my 4WD off road I tow a Caravan, Boat or Trailer I have worked on my car in the last 3 months I am into performance cars I use the internet: At Home At Work Please tick here if you do not wish to receive marketing materials* I agree to the terms and conditions of the program (see overleaf)1. The card must be presented at the point of sale. 2. Repco reserves the right to change the terms & conditions of the program atany time. 3. Repco reserves to the right to review the members benefits from time to time 4. The card remains the property ofRepco Ltd 5. Offer excludes purchases of Gift cards. 6. Cards are not credit cards.* Applicants signature:________________________________________________________ Date: / /20OFFICE USE ONLYReference: E3 E9 T8 Home Location: Store No:Store Manager Sign:
<strong>CARD</strong> <strong>APPLICATION</strong> <strong>FORM</strong>Please complete all fields to insure the prompt issuance of your Card. Please lodge your application at your local <strong>Repco</strong> Store for approval.* Mandatory fieldsCONTACT DETAILSBusiness Name:ABN:* Title: Mr. Mrs. Miss Ms* First Name:* Surname: Birth date:/ /* Please enter at least one contact phone numberWork Telephone No. Mobile No. Home Telephone No( ) ( )* PREMISES ADDRESS: POSTAL ADDRES: Tick here if same as Premises Address* Street Address: Street Address:* Suburb: * State: * Postcode: Suburb: State: Postcode:Email Address: (use block letters)I prefer to be contacted by: (please check all that apply) Email SMS Mail* I am best described as: (please check one box)GENERAL IN<strong>FORM</strong>ATION* How much would you expect to spend per month?(please check one box) General Motorist Do It Yourselfer Between $150 and $500 Between $501 and $1500 Serious Car Enthusiast Automotive <strong>Trade</strong> Professional More than $1500* How often would you visit a <strong>Repco</strong> Store: (please check one box) Weekly Fortnightly Monthly Yearly Never* Do you own a business / What type of business do you have? (please check the one box that best describes your business) No Business (move to nextsection) Agricultural Machinery Air Conditioning Steering & Suspension Diesel Mechanic Car Dealership Auto Electrician Wrecking Yard General Automotive Panel Beater Exhaust Specialist Service Station Towing Mobile Mechanic Radiator Specialist Brake/Clutch Specialist 4WD Specialist Marine Mechanical Tyres EFI Diagnostics Gas Conversion Truck Specialist Carburettor Specialist Engine Reconditioner Motorcycle Specialist OtherTell us a little bit about you? (please check all applicable boxes)PROFILE IN<strong>FORM</strong>ATION I regard my car simply as transportation I am passionate about cars I am into motor sports I take motoring holidays I own a motorbike I own a 4WD I take my 4WD off road I tow a Caravan, Boat or Trailer I have worked on my car in the last 3 months I am into performance cars I use the internet: At Home At Work Please tick here if you do not wish to receive marketing materials* I agree to the terms and conditions of the program (see overleaf)1. The card must be presented at the point of sale. 2. <strong>Repco</strong> reserves the right to change the terms & conditions of the program atany time. 3. <strong>Repco</strong> reserves to the right to review the members benefits from time to time 4. The card remains the property of<strong>Repco</strong> Ltd 5. Offer excludes purchases of Gift cards. 6. Cards are not credit cards.* Applicants signature:________________________________________________________ Date: / /20OFFICE USE ONLYReference: E3 E9 T8 Home Location: Store No:Store Manager Sign:
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