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Gym Concession Form
Use this form to buy single classes or concession card
TAX INVOICE
GST 13-048-959
Please note: all personal details will be kept strictly confidential
Name
*
First name
Last name
Address
Address line 1
Address line 2
Address line 3
Address line 4
Town/Suburb
City
Postcode/Zip
Email address
*
Other phone
Cell phone
Payment Options
Eftpos or Cash payments available at our office
Online Banking to BNZ account 02 1257 0062965 000
Gym Concession Card,
10 Concession Card
20 Concession Card
Other amount
$
10 Concession Card
20 Concession Card
Other
$
Casual Class
1 Class
Other amount
$
1 Class
Other
$
Donate a concession card for another service user
$100.00
$300.00
$500.00
Other amount
$
$100.00
$300.00
$500.00
Other
$
Pay/Donate method
*
Credit Card
Direct Credit
Make deposit to account
02-1257-0062965-000
Pay processing fee
$
Total amount
$
Please check the highlighted fields
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