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Download (0.21 MB) - Australian Council on Healthcare Standards

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ACHSI PUBLICATION ORDER FORM<br />

Postage Details<br />

Name:<br />

Positi<strong>on</strong>/Dept:<br />

Organisati<strong>on</strong>:<br />

Delivery Address:<br />

Suburb: State: Postcode:<br />

Teleph<strong>on</strong>e:<br />

Fax:<br />

Email:<br />

Billing Address:<br />

(if different from delivery address)<br />

Suburb: State: Postcode:<br />

Purchase Order Number:<br />

METHOD OF PAYMENT<br />

Cheque enclosed for: A$ ______________________________________________________________<br />

MAKE PAYABLE TO: The <str<strong>on</strong>g>Australian</str<strong>on</strong>g> <str<strong>on</strong>g>Council</str<strong>on</strong>g> <strong>on</strong> <strong>Healthcare</strong> <strong>Standards</strong><br />

Charge to: Mastercard VISA AMEX<br />

Card Number: __ __ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___<br />

Expiry Date: _____ / _____<br />

Cardholder: __________________________________________<br />

Signature: __________________________________________<br />

EFTe / Direct Debit:<br />

Bank Name: Comm<strong>on</strong>wealth Bank of<br />

Australia<br />

BSB: 062 009<br />

Account No: 00802252<br />

SWIFT Code:<br />

Name:<br />

CTBAAU2S<br />

The <str<strong>on</strong>g>Australian</str<strong>on</strong>g> <str<strong>on</strong>g>Council</str<strong>on</strong>g><br />

<strong>on</strong> <strong>Healthcare</strong> <strong>Standards</strong><br />

Please return completed form with payment to:<br />

Publicati<strong>on</strong> Orders<br />

ACHS Internati<strong>on</strong>al<br />

5 Macarthur Street ULTIMO NSW 2007<br />

Tel +61 2 9281 9955 E-mail achsi@achs.org.au<br />

The <str<strong>on</strong>g>Australian</str<strong>on</strong>g> <str<strong>on</strong>g>Council</str<strong>on</strong>g> <strong>on</strong> <strong>Healthcare</strong> <strong>Standards</strong> Internati<strong>on</strong>al (ACHSI) Page 2 of 2

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