Rspca Qld Cadbury® Chocolate Fundraising Order & Payment Form

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OFFICE USE ONLY □ PAID □ ACCOUNTS □ RECEIVED RSPCA QLD CADBURY® CHOCOLATE FUNDRAISING ORDER & PAYMENT FORM Complete all relevant sections and return to Email: [email protected] Fax: (07) 3258 5608 Post: Locked Bag 3000, ARCHERFIELD BH QLD 4108 PERSONAL DETAILS (please complete all details even if you have ordered before) Name Organisation (if applicable) Address Contact numbers Landline: Mobile: Email Where will you be selling the chocolates? How did you hear about Cadbury® Chocolate fundraising for RSPCA Qld? (please mark) RSPCA Qld Website RSPCA Qld Facebook Page RSPCA E-Newsletter Cadbury Website Work colleague Family Friends Previous Cadbury Chocolate fundraiser YOUR ORDER ($60.00 per box. There are 50 chocolates in each box) Pack Type Number of boxes Cadbury Mixed Fun Pack Includes; 100s & 1000s Freddos, Milk Chocolate Freddos, White Chocolate Freddos, Peppermint Freddos, Strawberry Freddos and Caramello Koalas Cadbury Mixed Variety Pack Includes; Time out, Cherry Ripe, Crunchie and Boost bars Cadbury Half & Half Pack Includes; a mixture of Mixed Fun Pack and Mixed Variety Pack as above Europe Bars Pack Includes; a mixture of Summer Rolls and Nougat Honey Log Total number of boxes: COLLECTION DETAILS Once you have received payment confirmation via email or phone, the chocolates will be available for collection from the RSPCA Qld head office at Wacol, approximately one week later - sometimes earlier! Please let us know when you plan to pick them up so we can have them ready for collection. RSPCA Qld Head Office: 139 Wacol Station Rd Wacol Qld 4076 DELIVERY DETAILS (15 boxes or more) If you are ordering 15 boxes or more and would like free delivery, please complete the following delivery details. If the delivery details are the same as above, please still complete this section. Name Company Delivery Address Phone Special instructions and hours for delivery PAYMENT DETAILS Visacard Mastercard Amex Cheque Money Order Direct Deposit Card Number Expiry CCV Total amount Signature Cheques/Money Order: Payable to: RSPCA Queensland Inc Post to: Locked Bag 3000, ARCHERFIELD BH Qld 4108 EFT/Direct deposit: Bank: Westpac Name: RSPCA Fundraising Account. Acc No: 169 350 BSB: 034-033 *Please email proof of bank deposit transfer to [email protected] CONFIRMATION By signing this document I agree to comply with the terms and conditions of the Cadbury Chocolate Fundraising drive as outlined above. Name: Signature: Date: For all enquiries, contact: [email protected] or (07) 3258 5608. .

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