Thank you
Your guarantor form has been submitted. A signed copy has been emailed to the guarantor.
Guarantor Form
Member Name:
*
This field is required.
Name of Guarantor
*
This field is required.
Date of Birth of Guarantor
*
Day
Month
Year
This field is required.
Email of Guarantor
*
This field is required.
Mobile Number of Guarantor
*
This field is required.
Address of Guarantor
*
This field is required.
Suburb of Guarantor
*
This field is required.
Post Code of Guarantor
*
This field is required.
Relationship to Member:
*
This field is required.
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:
*
Sign here
Clear
This field is required.
Members Signature:
*
Sign here
Clear
This field is required.
Date Signed:
Day
Month
Year
Please enter a valid date.
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)
Website
Submit
