AACASA Adoption Support Package Request Form

Name
Address
Postcode		Email
Phone			Fax
Please indicate the age of children you intend to adopt so you can receive appropriate information.
Probable date your file will leave Australia.
Applicant Type New rates as off April 2005	Option 1 Package with 1 1 1 international courier consignment slips. Usually the best for NT and SA. NB NT May change as NT now handling files.		Option 3 Package with 2 domestic and 4 international courier consignment slips. Usually the best for Qld, Tas, WA and ACT	Option 4 Package with 3 international courier consignment slips. Usually the best for VIC and NSW
Price ##	AUD$260		AUD$510	AUD$380

· Prices Revised April 2005. & with the reduction all (1^st, 2^nd) are at the same rate.

· ## "For genuine hardship in meeting the cost of the package, subsidized packages are available at reduced prices on application to the Executive”

· ++ Credit Card Fees ($1.50 upto $149.00; $2.50 $150-$349; $4.00 $350.00-$499.00  & $5 $500+ )

Prices are valid until Dec 2005. If you are unsure please consult with your state department or AACASA state representative on which is the best option for you.

If your state is not mentioned in the options above you will need to contact your department or AACASA State Representative for which option is best for you.

Post this completed form and Payment Advise below with Payment to: [Please do not send CASH]

AACASA Inc.

PO Box 1319

Milton Centre

Milton Q 4064

Payment Advice: Purpose: AACASA Inc. Package Option [___] [[ DO NOT SEND CASH ]]

Please fill in Payment details [Please note Any Credit Card Fee’s incurred will be added to the total
Credit Card Fees ($1.50 upto $149.00; $2.50 $150-$349; $4.00 $350.00-$499.00 & $5 $500+ )

Amount $ __________________ Cheque/Money Order q Visa q MasterCard q Bankcard q

Card Number

Expiry Date ___ / 20__

Name on Card: Signature: