Application to buy an IdeasBank RED Memon Slot

Our mail address is: PO Box 27, Subiaco, WA 6008, Australia.
Our International Fax: +61-8-9388 1852

If you have any difficulties with this form, please e-mail or fax us instead:
ideasbank@AOI.com.au

If you wish, review Pros and Cons of Red-Memon Purchase here.

Registering a slot purchase is not automatic. Applications will be processed strictly in order of receipt and may take up to a week or more to show up on the website. Applications can be paid for by credit card or by electronic transfer to a United States bank account.

Please complete the form below. Fields marked '*' are required for successful submission. Received applications will be acknowledged by e-mail, slot purchase receipts will be forwarded by e-mail or fax as preferred.

Your Contact Details:

*Name:
Organization:
*Mail Address:
*Email:
Phone:
Fax:

 

Memon Slot applied for:

*Memon reference number (eg 4321):
Memon title:
Memon Class: RED

*Do you understand that you will be required to complete a Non-Disclosure Agreement?
Yes    No
(An NDA can extend to 1, 2, or 3 persons, each jointly and severally liable).

*Do you understand that you will be required to complete an IdeasBank Development Agreement?
Yes    No

 

Payment Amount and Method:

*Cost of Non-refundable Deposit on Slot Purchase (United States dollars) USD:
(The non-refundable deposit is equal to half the total red-memon slot price. Currently the deposit required is US$5000).

Orders may be paid by charging to your Mastercard, Visa, Diners, Amex, or Bankcard account or by transfer to a US bank account.
Please indicate:

Name on Card: Expiry Date :
Card Number: please type in number or indicate how number will be supplied (eg fax)

(We will supply the account details of the US bank account to receive the transfer with your order acknowledgement).

After payment has been cleared, would you like your receipt sent by e-mail or fax?
E-mail    Fax.

Details all checked?
Click here to despatch your order: .
or you can click here to
--- and thank you.


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