2021 Charity Shield Official Rabbitohs Pre Game Hospitality By completing this form, the Company accepts the offer from the South Sydney Rabbitohs for the 2021 Season. Please return your completed form to: Account Manager Corporate Hospitality, South Sydney Rabbitohs, Level 4, 558A Anzac Parade Kingsord 2032, or fax (02) 8306 9911 or email [email protected]. For all enquiries please call (02) 8306 9997. COMPANY DETAILS Company ABN Postal Address Suburb State Postcode INDIVIDUAL DETAILS OR AUTHORISED COMPANY REPRESENTATIVE Contact Name Position Contact Number Email PACKAGE OPTIONS Function only Cost $100pp Ticket QTY Total cost $ (Price inc GST) Function & GA Ticket Cost $125pp Ticket QTY Total cost $ (Price inc GST) Function & Grandstand Ticket Cost $145pp Ticket QTY Total cost $ (Price inc GST) PAYMENT DETAILS Grand Total inc GST $ EFT Payment - Tax Invoice with Bank Details and Reference to follow Cheque - Made payable to SSDRLFC Credit Card Visa Mastercard AMEX Diners Card Number / / / Expiry Date / CCV Name on Card Signature A 3% surcharge applies to all AMEX & Diners card transactions DECLARATION I agree to purchase the above Rabbitohs Hospitality Charity Shield 2021 and have the authority to enter into this agreement on the Company’s behalf. Signature Date I have read the Terms and Conditions of this agreement outlined on the website or provided by SSDRLFC *By signing this form and ticking the Terms & Conditions box above, you are unconditionally confirming your acceptance of the Corporate Partnerships Agreement, its terms & conditions and payment terms. This form is a legally binding contract (Agreement) between the company or person/individual named on the form (Client) and the South Sydney District Rugby League Football Club ABN 28 002 487 390 (SSDRLFC). Please retain a copy of this document for your own record..