How Did You Hear About Us. (please select): Do you have any additional locations you would like to establish an account for? If so, please attach information for each location (company name, contact name, address, phone, fax, email). DISTRIBUTOR PROFILE/CREDIT AGREEMENT (continued) Trade References:
How Did You Hear About Us. ❑ Website ❑ Referral* ❑ Signage ❑ Flyer ❑ Advertisement ❑ Other: * If referred, please provide us with the details of who referred you: PARENT DECLARATION I have read and agree to each of the sections and terms and conditions of this Agreement. I consent to each of the provisions in this Agreement that requires my written consent. These include: ❑ Enrolment Details ❑ 20 Hours ECE Attestation ❑ Dual Enrolment Declaration ❑ Medicines, Category (i) Medicines ❑ Medicines, Category (iii) Medicines ❑ Consents and Declarations I have supplied the following documents: ❑ Child’s Birth Certificate/Identity (sighted) ❑ Child’s Immunisation Certificate ❑ My Identification I have finalised arrangements for Fees ❑ First Week Enrolment in advance I have been provided with: ❑ Parents Handbook ❑ Fees and Enrolments Policy (applicable as at day of enrolment) ❑ Confirmation of your child’s start date I declare that all the above information is true and correct to the best of my knowledge. PARENT / GUARDIAN SIGNATURE: DATE: SERVICE DECLARATION Signed on behalf of Bumblebees. I declare that this form has been checked and all relevant sections have been completed. CENTRE MANAGER: DATE: OFFICIAL USE Week 1 Fee: Child Reference: Data Entry Date: Centre Visits: Immunisation Cert: Birth Cert signhted: Enrolment Date: Start Date:
How Did You Hear About Us. Thank You for choosing Phoenix Realty and Property Management, Inc.
How Did You Hear About Us. ❑ TV advertisement ❑ Print ad in ❑ News story in ❑ Facebook ❑ Twitter ❑ Morningstar ❑ Lipper ❑ Internet search ❑ Friend/Relative ❑ Conference ❑ Financial Advisor/Broker ❑ Other
