Smart PDF Form

Member Name:*

Name of Guarantor*

Date of Birth of Guarantor*

MonthDayYear

Email of Guarantor*

example@example.com

Mobile Number of Guarantor*

Please enter a valid phone number.

Address of Guarantor*

Suburb of Guarantor*

Post Code of Guarantor*

Relationship to Member:*

I HEREBY GUARANTEE THAT THE ABOVE NAMED MEMBER WILL HONOUR THE PAYMENT OBLIGATIONS HE/SHE HAS MADE UNDER THE CONTRACT BETWEEN THE ABOVE NAMED MEMBER, DEBITSUCCESS PTY LTD AND GALLIPOLI FITNESS:

IF THESE OBLIGATIONS ARE NOT MET I UNDERSTAND THAT I MAY BE HELD PERSONALLY LIABLE FOR ANY DEBT OWING BY THE MEMBER AND TAKE THE PLACE OF THE MEMBER UNDER THE TERMS OF THE CONTRACT THE MEMBER HAS ENTERED INTO. I HAVE READ AND UNDERSTOOD MY OBLIGATIONS AS GUARANTOR.

Guarantors Signature:*

Members Signature:*

Date Signed:

DayMonthYear

The issuer of the billing service is Debitsuccess Pty Ltd (ABN 32 095 551 581). Debitsuccess is an Authorised Representative (AR 407894) of Transaction Services Holdings Limited (AFSL 338256)

Guarantor Form