Vintage Marketplace BOM Registration Form

'Vintage Marketplace’

Block of the Month Registration Form
$35 per month for 10 months
(plus $7.50 tracked postage if required)
Name*

First NameLast Name
Postal Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Daytime Phone Number*

Area CodePhone Number
POST or COLLECT:*

Post ($7.50 tracked postage per month)Collect (from Blue Mountain Heights, QLD)
Our Block of the Months are charged and posted (or available for collection) on the 1st Tuesday of each month.
Once you have submitted your BOM Form, we will be in contact via phone to collect your payment details - all payment details are securely stored (credit/debit card).

** PLEASE NOTE: by submitting this form, you are agreeing to purchase one block per month for the duration of the BOM program. If your payment declines, admin fees may apply.
Should be Empty:

'Vintage Marketplace’