Manawatu Rugby Union 500 Club
OUR COMMUNITY, OUR TEAMS, MANAWATU PROUD
Details:
Business Name
*
Full Name
*
First Name
Last Name
Phone Number
-
Area Code
Phone Number
E-mail
*
example@example.com
Would you like to collect your pack or have it delivered?
*
Collect - Collect from 30 Waldegrave Street, Palmerston North
Delivered - Please add delivery address below for Palmerston North Delivery
Delivered- Outside of Palmerston North $10
Postal Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Would you like to be invoiced?
*
Yes - Please supply email address below
Pay via credit card
Email Address for invoice to be sent to:
example@example.com
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500 Club- Pay Via Credit Card
Join an elite squad of supporters dedicated to making NPC and FPC epic.
$
500.00
NZD
500 Club- Please Invoice me
$
Free
NZD
Quantity
1
2
3
4
5
6
7
8
9
10
Delivery- Outside of Palmerston North
$
10.00
NZD
Quantity
1
2
3
4
5
6
7
8
9
10
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
If you know anyone who might be a great fit for the 500 Club, feel free to send their name our way!
Rows
Full Name
Contact Number or Email Address
1
2
Signature
*
Date Signed
*
-
Month
-
Day
Year
Submit
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