Order Form Instalments Option
Please print this form out then fill in the details and sign. Your order will be processed on receipt of this form and the program posted today.

Post to:  Elite Racing Data Pty Ltd     or:    FAX   (08) 9524 7633
                    PO Box 1345
                    Booragoon  WA   6954

Authority   (Credit Card orders only)

To Elite Racing Data Pty Ltd:  Please supply the Elite-Multi 2009 program in accordance with the following signed, legally binding authority:  I hereby authorise Elite Racing Data Pty Ltd to deduct from the credit card (details below) a deposit of $490 immediately and then ELEVEN monthly instalments of $127on the 5th of each month thereafter, a total of $1,887 (Includes GST). I agree that by taking out this Pay-By-Instalments option, I am legally bound to pay Elite Racing Data Pty Ltd the deposit and all repayments as above. I agree to keep Elite Racing Data Pty Ltd provided with current credit card details for the term of the contract.  


 Visa / MasterCard / Bankcard Number:  _ _ _ _/_ _ _ _/_ _ _ _/_ _ _ _


Expires: ____/____     Name On Card:___________________________________


Cardholder's Signature:________________________  Date: _________________

Name:__________________________________________ 

Address:_______________________________________________P/Code_________

Phone:__________________________  Mobile:____________________________

 Email:_________________________________________________________