Automatic Fee Payment to Biame Network Inc.

AUTOMATIC FEE PAYMENT TO BIAME NETWORK INC.

FORMAL AUTHORITY

Complete this Authority, if you want your Membership Fee and/or Training Fee automatically
deducted from your credit card when they fall due. This is a very efficient means for us
to take care of your payments. If you do not complete it, we will bill you by ordinary mail.

You have two options:

You can apply Online using this form, or
You can Print Out Another Form Here, that you can then fax, or mail to us.


NAMES
Last Name:      
First Names:  

ADDRESS
Street:        
City:          
State:           
Country:        
Area/Zip Code: 

TELEPHONE AND OTHER CONTACTS
Home:       
Work  :   
Fax:      
Mobile:   
Email:    
WEBSITE:  

DECLARATION

I agree with the Biame Network Inc. that it may use my credit card to pay the fee(s), 

as set out below, every year, until I contact the Biame Network Inc. and change this arrangement.  

I understand that these fees may change from time to time and agree to pay whatever 

the fee is at the time it is levied.  I understand  that it is my responsibility to contact 

Biame Network Inc., if I want this arrangement changed in any way.

I understand that the arrival of this declaration at Biame Network.Inc. is the beginning 

of the above arrangement.


PAYMENT AUTHORITY

Please pay my: 	
	  Annual Membership Fee  (Currently: $55.00 p.a. )	
	  Annual Training Fee  (Currently: $50.00 p.a.)
(check one or both boxes as appropriate) by credit card in accordance with the above declaration. 
I am paying by  my Credit Card 

My credit card is:  


Number:  

Valid from(mm/yyyy):  /    Valid to(mm/yyyy):  /

Date of Completion of this form is:

REMEMBER TO PRINT THIS FORM FOR YOUR RECORDS USING YOUR BROWSER

ABOUT BIAME NETWORK DIRECTORY

roduced by Biame Network Inc., P.O. Box 271, Seymour, Victoria 3661, Australia
Telephone: 1800 244 254 (Freecall in Australia); +61 3 5799 1198 (International)
Facsimile: +61 3 5799 1132
Email: biamenet@eck.net.au
Website: www.biamenetwork.net