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Unless previously notified, we aim to deliver your hilbarn fresh produce box to your Pick-Up Point or home address by 2pm each Tuesday. Personal information collected under this subscription will only be used for the purpose of assessing your application. This process may include the exchange of information with government departments or agencies for compliance purposes. Information may also be disclosed to Registered Agents for the purpose of verifying details of applications. Hilbarn fresh produce reserves the right to refuse any application if the information provided is incomplete or does not meet the required criteria.
hilbarn SUBSCRIPTION FORM (PLEASE COMPLETE IN BLOCK LETTERS) Full Name: __________________________________________________________ Residential Address: __________________________________________________ Delivery Instructions:__________________________________________________ Home Phone No: _____________________ Work Phone No: __________________ Mobile No: _______________________ Email: _____________________________ Please nominate the number of $30 or $55 boxes (delivered to Hobart): $30 boxes: 4 boxes ($120) ______ 8 boxes ($240) ______ 12 boxes ($360) _______ $55 boxes: 4 boxes ($220) ______ 8 boxes ($440) ______ 12 boxes ($660) _______ Please tick your delivery preference: Weekly_________ Fortnightly________ Fresh Eggs (Optional): Free Range____$6 doz / Organic Free Range____ $7.50 doz Boxes available for you to collect from Pick Up Points on Tuesdays by 2pm. Tick your preference or select home delivery (within a 10km radius of Hobart CBD): Hilbarn Hobart Pick Up Points: _________Bottega Rotolo, 141 Bathurst St, parking off Harrington (930am 6pm) _________Domain Tennis Centre, Reception, The Domain, Hobart (9am 6pm) _________ Southern Cross Media, 75 Liverpool Street _________Kettering Service Station, 2956 Channel Hwy, Kettering or _________ Home/Work Delivery (available for an additional $5 per box within a 10 km radius of Hobart CBD. Please include the delivery fee in the total amount payable to hilbarn i.e. 4 x $30 boxes + home delivery = $140).
YOUR RESPONSIBILITY
I acknowledge it is my responsibility to collect my hilbarn fresh produce box from my nominated Pick-Up Point. I certify that, to the best of my knowledge, all of the above details are correct at the time of completing the form. Providing false or misleading information is a serious offence and carries penalties under the Criminal Code Act 1995. I agree as the applicant that I have and will provide payments for hilbarn fresh produce prior to the time of delivery. I acknowledge as the applicant that hilbarn fresh produce has no liability for any loss, damage or cost incurred as a result of, or arising from, the goods or products or items or services provided by hilbarn fresh produce. Your signature: ____________________________________ Date: ____________
hilbarn PAYMENT DETAILS Pre-payment for hilbarn fresh produce can be made by Direct Deposit to: Account name: Bank: BSB No: Hilary Burden and Ross Bennett Commonwealth Bank of Australia 067-601 Account No: 10264818
* Please use your name in the transaction description to identify your payment. Or, pay by cheque (payable to Hilary Burden & Ross Bennett) and post it with your signed Subscription Form. Please forward your completed hilbarn fresh produce subscription form to: hilbarn fresh produce, 1065-1074 Pipers River Road, Karoola TAS 7267 Call Hil on 0431 749 804 or Barn on 0418 524 064 Email address: hilbarn@bigpond.com. Web www.hilbarn.com Find us on Facebook. Twitter @hilbarn
A Christmas Berry Box Thank you. We look forward to sharing the delights of fresh local produce with you.