association of massage therapists ltd
AMT Merchandise Order Form (AMT Members only) Receipt books with AMT logo - A5 size (100 leaves) $12.00
Date:
“What is massage therapy?” DL trifold pamphlets
Receipt No:
Received from: The sum of: Being for: Signature: Consultation: $ GST:
$
Amount:
$
PROVIDER NUMBER/S
25 - $17 + $5 postage 50 - $30 + $8 postage 100 - $55 + $10 postage
Member Number:
Postage for: 1 book - $5.00; 2-4 books - $8.00; 5 books - $10.00
ITEM
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TOTAL Name: Member Number: Address:
I have enclosed my cheque or money order (made out to AMT) OR please debit my Visa/Mastercard (for banking purposes circle correct one)
Cardholder’s Name: Cardholder’s Signature: Card Number: Expiry Date:
Association of Massage Therapists Ltd PO Box 826 Broadway NSW 2007 T: 02 9211 2441 | F: 02 9211 2281
[email protected] www.amt.org.au
EFT PAYMENT DETAILS PLEASE USE YOUR NAME UNDER THE TRANSACTION DESCRIPTION SO WE CAN IDENTIFY THE PAYMENT AND SEND THIS FORM BACK TO AMT Account Name: Association of Massage Therapists Ltd BSB: 062-212 Account Number: 1034-0221
