Care Control Booking Form

CAR CONTROL COURSE - ENROLMENT FORM OR GIFT CERTIFICATE - Click here to download

Each person is required to attend in a separate car to ensure you receive the full benefit from the time allocated to you in each exercise. Your booking may be secured by sending/faxing this enrolment form and payment for the full amount of the course fee: $280.00 inc.

Refunds are not available but you may transfer to another course with one week's notice. Full payment must accompany application forms and you may pay by cash, cheque or any of the credit cards listed below.

We will confirm your booking for the course day selected after payment received. Please enrol the following person in the Car Control Course:

Date of course required: ..........................................................

(Roadcraft courses must be booked by telephone for a mutually convenient date)

Name: ........................................................................................

Address: .....................................................................................

.......................................................Post Code ...........................

Phone: (.......)............................... Mobile ....................... Email ........................

On "P" plates?...........

Car make and model: ..................................................................

TAX INVOICE (ABN 74141 869 669)

I enclose cheque/money order for $...........................

I authorise you to debit my account with the following amount $......................

YOUR NAME ON CARD ...........................................................

Card No. __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __  CVN .............

EXPIRY DATE ....../......./....... AMOUNT ................. CARDHOLDER’S SIGNATURE ..........................................

TICK CARD: Bankcard‚ Mastercard‚ VISA

To pay by direct bank debit, send monies as detailed below and put the receipt number on enrolment form:

Account Name: FFEA PTY LTD

Bank: ANZ

Branch: Chipping Norton

BSB: 012 087

Account number: 369 097 375

NATIONWIDE DEFENSIVE DRIVING SCHOOL (ABN 74141 869 669)

RTA instructors licence 011609

10 Finschhafen street, Holsworthy NSW 2173

Tel: 0430 777 000 / 1300 900 619  Fax: (02) 9825 1802 e-mail: office@finlays.com.au

OFFICE USE ONLY (Form 18/6/10):

CONFIRMED .............................................................................

PAID ............................................GST : ....................................

COURSE COMPLETED ............................................................

GRADE ......................................................................................