You are on page 1of 1

Advertising in the Green Guide Application Form



Business Address

Name of Contact

Phone number

Advertising Space Wanted

Selection Size Dimensions Price (ex GST)

1/4 Page portrait W65mm x H73mm $80

1/2 Page landscape W131mm x H87mm $180

Whole page W136mm x H165mm $360 (Limited availability)

Description of Services Checklist

Please provide a short description of your product/service I have attached a copy of my logo/image

I have attached the text to

accompany my logo in my advert

I have confirmed my payment

Payment Method method

Cheque Direct Deposit

Terms & Conditions
Post to: A/c Name: Energy Innovation
PO Box 111 Co-Operative Ltd I agree to the Co-ops terms and
Inverloch,VIC 3996 A/c no.: 137757159 conditions
BSB: 633000
Ref: 2016/17 Green Guide Ad

Please email this form back to

Energy Innovation - Co-operative ABN: 18 807 187 154 - PO Box 111, Inverloch,VIC 3996