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Shop Application for Advertising

Please complete all sections of the Application for Advertising. When a form field is the same eg. address and postal address, type in "same". If you supply mutiple types, check multiple boxes.
 
Business Name
ABN
Owner's Name
Street Address
Town/Suburb
State
Postcode
Postal Address
Town/Suburb
State
Postcode
Email Address
Telephone
Mobile
Website Address
Type Books
Camera/Photo
Clothing
Gifts
Hairdresser
Hardware
Internet Cafe
Newsagency
Pharmacy
Supermarket
Variety Store
Other
Description
(Thirty Words)
Photo
Facilities for Special Needs Disabled
Disabled Assisted
Hearing Impaired
Visually Impaired
Comments
Person Submitting the Application Form
Name
Position
Telephone
Email
Fax
Advertising Time  1 Year  ($55)
I agree to the Advertising Terms and Conditions
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