Pursuit Entry Form

"use this form below to electronically submit, for other methods just print out this form"

 

             3/4th October, 2009  

 

Team name :          

Team postal address:

Team email address:  (Will email instead of post)

Telephone number with contact name:   

Driver:

Navigator:

 

Total cost is:

 

$250 (inc.GST)per Team of 1 vehicle

 

Includes all relevant maps

 

 

 

Total Amount

$

Credit Card Number *note 1.5% surcharge applies if paying by credit card
Expiry Date  
Account Name

Post with a cheque or money order payable to Paoletti's Maps to 15 Nirvana Close, Langwarrin South Vic 3911.

Direct debit is also accepted. Account Name: Paoletti's Maps  BSB: 033138  ACCOUNT NO: 136980. WESTPAC.

Or fax your entry form on (03) 9776 6798 or Telephone 0428 534 102