Membership Application Form

Business Name *

Business Category * Select OneAccommodationAccountingAgricultureAir ConditioningAutomotiveBanksBeauty ServicesBuilding ServicesCleaning ServicesClubs/OrganisationsComputer Sales/ServiceConveyancingDelivery & TransportDisability ServicesEducationEmployment & TrainingEventsFinancial ServicesFloristFurniture - RetailHealth ServicesHome DecorHome ImprovementHotelInsuranceLegal ServicesLocal ProduceLocksmithMarketingMediaMembers of ParliamentOtherPrinting & Graphic DesignProfessional ServicesReal EstateRecruitmentRestaurant/CafeRetailShoes - RetailSportingTelecommunicationsTradesTravel/TourismWinery

Billing Address *

City *

State/Province *

Zip/Postal Code *

Country *

Australia

Email *

Phone Number *

Use this billing address as my business address.

How did you hear about us?

First Name *

Last Name *

User Name *

Password *

Membership Level *BVH Associate - Annual: $204.54BVH Kickstart - Annual: $204.54BVH Basics - Annual: $253.64BVH Essentials - Annual: $722.72BVH Platinum - Annual: $2253.63Reciprocal Business SA membership: $0.00

Tax

Total Due:

Payment Method:  WC Payments

Terms & Conditions Statement: Data submitted through this form will be used for the purpose of creating your directory listing and managing your membership. Please see our Privacy Policy for more information on how we protect and manage your data.

I consent to having Business Victor Harbor collect my data via this form.