KaneffGolf Membership Application Form 2015 OFFICE USE ONLY

KaneffGolf Membership Application Form
2015
Applicant Name _____________________________________________
Billing Address _____________________________________________
Membership Details
Course
_____________________________________________
Home Phone ____________________Cell ________________________ _________________________
Work Phone ____________________Fax ________________________ Type
Email ______________________________________________________ _________________________
(email address will not be sold to soliciting companies)
If applicable:
Junior’s Name:____________________________ DOB: ______________
Credit Card Information:
*Please note that the applicant must be the primary card holder for the credit card being authorized
for payment herein. Name and address of the applicant must match the billing information on the
selected credit card.
Card Type
$______________ Membership Fee
Credit Card Number __________________________________________
$______________ HST 13%
Expiry Date __________ / _____
$______________ TOTAL
By signing and submitting this Application, I acknowledge that I have read the Terms and Conditions and agree to be
bound by them. I certify that the information I have provided is accurate and will advise KaneffGolf if there is any
change in my credit card information or in the event my credit card is cancelled, lost or destroyed. I agree that the
purchases I make using my KaneffGolf Membership Card will be charged to my designated credit card account on
a monthly basis and I agree to pay such charges in accordance with the terms and conditions of my card agreement
with my designated card issuer. Use of my KaneffGolf Membership Card will confirm my acceptance of the Terms
and Conditions.
I agree to provide the above credit card information, as updated by me from time to time, so that KaneffGolf may
set up, administer and service our business relationship. KaneffGolf may verify the accuracy of this information by
obtaining additional information from credit bureaus and my designated card issuer.
Signature: ________________________________________
Date: ___________________________
OFFICE USE ONLY
Membership Type ____________________________
Sales Consultant ______________________________
Membership #_______________________________
Method of Payment ___________________________