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Smartcard Application

If your institution has access to a Genesearch e-freezer, you can use this form to apply for a Smartcard so you can use the e-freezer.

The cost of the SmartCard is $11.00 including GST. This amount will appear on the card's first monthly statement: you do not have to raise a separate order for it. Extra cards and replacements for lost or damaged cards are also $11.00 each including GST. Faulty cards will be replaced free of charge.

Each card can accommodate 1 to 10 users, with individual passwords and optional individual budget limits and expiry dates.

NOTE: You must have permission from your Accounts Department to acquire and use a SmartCard. They might also require assigning a Standing Order or Account Number to the card. If in doubt, check with your Accounts Department before filling in this application.

1. Contact and Invoicing Details >> 2. Card Details

* marks required fields

Your Contact Details

In case we need to contact you re this application.

Title:

First Name:*

Last Name:*

Email Address:*

Phone Number:*

Contact Person for the Card

This is the person we should contact re issues with the card, orders and other usage matters. If you are the contact person, leave this blank.

Title:

First Name:

Last Name:

Email Address:

Phone Number:

Delivery Details

Please enter sufficient detail for us to identify which of our customer accounts to attach your card to, and so any direct deliveries (of your smartcard and any items that cannot be put into an e-freezer) are shipped to the correct address:

Delivery Address:*

Invoicing Details

Name and address of the person who will receive the monthly statement/invoice.

Name:*

Address:*

City/Suburb:*

State:*

Postcode:*

Accounts Department
Email Address:*

This is the person to whom we will email the details of your application for their signed approval.

To avoid delays please ensure that this is the correct email address as your application cannot be finalised until they have signed.

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