LANDBASE AUSTRALIA REGISTRATION FORM
 LOCKED BAG 25 Gosford NSW 2250 Australia
Phone: (Australia) 0408 68 64 61 Office hrs. 0900-1700. AEST
After hours message bank in service
Fax: (Australia) 02 43 23 73 26
Phone: (International) +61 408 68 64 61 Office hrs. 0900-1700. AEST
After hours message bank in service
Fax: (International) +61 2 43 23 73 26
E-mail: landbase@landbase.com.au URL: http://www.landbase.com.au

NOTE: ALL FIRST AND SURNAMES MUST BE REGISTERED FOR SORTING PURPOSES

ALL FIRST AND SURNAMES OF ALL USERS
ALL OTHER NAMES:-Company/Business Names, Trust Funds, Yacht Names, Vehicle Names, Nicknames or any other names for our identification.
WHERE DID YOU HEAR ABOUT LANDBASE AUSTRALIA?
MODE OF TRANSPORT: CARAVAN    MOTORHOME      YACHT       OTHER                           (Please circle)
CURRENT ADDRESS:
CURRENT PHONE NUMBER:
MOBILE NUMBER:
EMAIL ADDRESS:
INTENDED DATE OF DEPARTURE:

*** SELECT REGISTRATION & POSTAGE COSTS TO SUIT YOUR NEEDS ***

12 MONTH REGISTRATION
TOTAL      $360.00
6 MONTH REGO
TOTAL      $190.00
3 MONTH REGO
TOTAL      $100.00

ADD     ADVANCE POSTAGE DEPOSIT IF TRAVELLING NATIONALLY                             
$70.00
OR        ADVANCE POSTAGE DEPOSIT IF TRAVELLING INTERNATIONALLY               
 $100.00

WHEN/WHERE APPLICABLE ALL FEES ARE INCLUSIVE OF GST. ALL FEES ARE QUOTED IN AUSTRALIAN DOLLARS.
REGISTRATION FEES WILL REMAIN VALID FOR THE DURATION OF YOUR REGISTRATION
POSTAGE AND HANDLING FEES MAY BE SUBJECT TO CHANGE.
NO REGISTRATION FEE OR PART THEROF IS REFUNDABLE AT ANY TIME

MY PAYMENT OF $___________ FOR ___MONTHS REGO

PLUS $_________ FOR MY ADVANCE POSTAGE DEPOSIT.

TOTAL PAYMENT ENCLOSED $_______________________

I ACKNOWLEDGE THAT LANDBASE AUSTRALIA WILL NOT BE HELD RESPONSIBLE FOR ANY PROHIBITED OR DANGEROUS GOODS SENT, OR LOST, DAMAGED OR STOLEN GOODS, AND, SHOULD ANY ILLEGAL ACTIVITIES BE CONDUCTED USING LANDBASE AUSTRALIA'S ADDRESS, REGISTRATION WILL BE DISCONTINUED IMMEDIATELY WITH NO REFUND APPLICABLE.

SIGNED: DATE ...../...../..... 

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