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Member Details
Business Name
* Contact Name
* Surname
* Email
* Address
* Suburb
* State
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* Postcode
* Postal Address
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* Mobile
Other Number
* Does the vehicle have pre-existing damage?
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Damage description
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Membership Details
* Purchase Order No.
* Your Stock Code
* Vehicle Type
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* Dealership
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* Product
Product Code
Product Price
Financier
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Macquarie
St George
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Finance Form
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Credit Card Details
Name on Card
Card Number
Expiry
Month
[01] January
[02] February
[03] March
[04] April
[05] May
[06] June
[07] July
[08] August
[09] September
[10] October
[11] November
[12] December
Year
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Vehicle Payment
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* Vehicle Make
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* Year
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2015
2026
2025
2024
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* Registration Number
* Colour
Uncheck the following to exclude alloy wheels not covered under the program
Alloy Wheels
Paint Protection
This car has paint protection
Retail Price
Download Customer Acknowledgement Form
If this membership is being Financed by Mitsubishi, Renault or Nissan Financial Services you must ensure the member Acknowledgement form is signed and immediately given to the business Manager
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