‘CHANGETHEGAME’CONTRIBUTIONFORM
Pleasecompletetheformbelowtobecomeapartof‘ChangetheGame’in2017.
ContributorDetails–pleasecomplete
Title:______Name:_________________________Surname:__________________________________
Company(ifapplicable):______________________________________________________________
ABN:__________________________________ACN:________________________________________
Position(ifapplicable)________________________________________________________________
PostalAddress______________________________________________________________________
Suburb/Town_________________________________State_______________Postcode__________
Phone___________________________________________Mobile_________________________
Email_____________________________________________________________________________
CONTRIBUTIONDETAILS–pleasecomplete
OnceMonthlyQuarterly
VALUE–pleasecomplete
SUPERHEROS–contributionsof$10,000+(excl.GST)$___________________specifyamountincl.GST)
DEFENDERS–contributionsof$5,000to$9,999(excl.GST)$______________(specifyamountincl.GST)
WARRIORS–contributionsof$500to$4,999(excl.GST)-$_______________(specifyamountincl.GST)
LOCALLEGENDS–contributions$20-$499(incl.GST)(individual/familycontributionsONLY)
$_______________________________(specifyamount)
PAYMENTOPTIONS–pleasecomplete
CreditCard–pleasecompletethisformandreturntoMackayCutterswithpayment
MastercardVisaNumber___________/___________/___________/___________
ExpiryDate______/______CCV:(numberonbackofcard)________Date:_______________________
Cardholder’sName________________________Cardholder’sSignature_______________________
DirectdeposittoourNABaccount:–pleasecompletethisformandreturntoMackayCutterswith
payment
AccountName:ChangetheGameBSB:BSB084789Acc:832626495Reference:Useyournameororganisationname
Inperson/phone/email–pleasecompletethisformandreturntoMackayCutterswithpayment
BBPrintStadium-2CaseyAvenue,Mackay,Qld,4740|POBox2005,Mackay,Qld,4740|
P:0749577780|E:[email protected]|W:www.mackaycutters.com.au|
https://www.facebook.com/ctgmackaycutters
IagreetotheMackayCuttersandChangetheGameacknowledgingthenameoftheabovecontributorand
theamountofthecontributioninalloftheirmarketing,promotionsandadvertising.
Contributersign:_____________________________________________________________
Date:_______________
Thankyouforyoursupport-Yourcontributionwillmakeadifference