GOLD MEMBER APPLICATION
 
 

SEND APPLICATION FORM TO:
CLASSIC CARLECTABLES CLUB
35 Bennet Avenue, Melrose Park SA 5039
PO Box 405, Melrose Park SA 5039

  Phone: (08) 8276 7722 Fax: (08) 8277 6252
Email: club@classiccarlectables.com.au 		 
 
ONE YEAR MEMBERSHIP

OPTION 1

Including:
Free CCC Car (Tick ONE box)

FORD
OR
HOLDEN

$45.00 including postage and handling

  

OPTION 2

Including:
Free CCC Car & Additional CCC Car

FORD
OR
HOLDEN

$90.00 including postage and handling
 
 
TWO YEAR MEMBERSHIP

OPTION 3

Including:
Free 1st year CCC Car (Tick ONE box)

FORD
OR
HOLDEN

Free 2nd year CCC Car (Tick ONE box)

FORD
OR
HOLDEN

$85.00 including postage and handling

  

OPTION 4

Including:
Free 1st year CCC Car & Additional CCC Car

FORD
OR
HOLDEN

Free 2nd year CCC Car & Additional CCC Car

FORD
OR
HOLDEN

$170.00 including postage and handling

 
 
NB: 2nd year FREE car is forwarded at the beginning of your second year, post FREE
  
 
PAYMENT DETAILS
PLEASE CLEARLY PRINT YOUR DETAILS IN CAPITALS
 
  Please debit my credit card:   VISA MASTERCARD Amount: AU$_______________  
  Card Number:          Expiry Date: /  
     
  Card Holder Name:_________________________________ Signature:_________________  
  OR  
  I enclose a cheque/money order made payable to Southern Model Supplies for: AU$_____________  
  Member Number (if applicable):

Surname:________________________ First Name:___________________________________

Address:__________________________________ Suburb:_____________________________

State:________________ Postcode:_____________

Phone: (     )______________ Mobile:_______________ Email:___________________________

All details must be filled in to be processed promptly
International members must make payment via credit card OR International Cheques in Australian Dollars