IGT Exclusive Membership Form

Upfront Payment Plan
Australia/New Zealand

First Name:*

Last Name:*

Email:*

Position Title:*

Company:*

Address:

Suburb:

Post Code:*

State/Country:*

Mobile/Cell:*

Please use your mobile phone number, for SMS Text verification purposes.*

How did you hear about this membership program?*

Other (please specify)

Instruction/Message (optional)

Item Price
AU$2,197 plus merchant card fees
I agree to pay AU$2,197 upfront plus merchant bank processing costs*. After 12 months, I understand that my membership will revert automatically to AU$197 a month plus card processing fees of 3%. To end the membership, I understand that I must give 30 days notice emailed to office@igtmail.com. Any amount that is payable within the 30-day cancel notice period will be charged to the card/account.*
*Please note that individual monthly invoices are available on individual requests. *STRIPE will be charging VISA/MasterCard with a loading of up to 3.0% and AMEX/Diners with up to 4.5%, calculated on the transaction value processed and a minimum transaction fee of AU$4.47 may apply. 
*Direct Debits (Australian accounts only) will incur up to AU$2.20 per transaction, with a one-time payment for the administration fee of up to AU$9.90 per Direct Debit request. A fee of up to AU$22 will be charged for every failed transaction with your card or bank account (charged by the merchant bank facility). All fees are stated in Australian dollars and inclusive of GST. STRIPE may waive, vary, or reduce the fees and charges in certain circumstances.
Item Amount
Dynamically Updated $XX.00
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