The Laura Aura - Subscribe to LEVITATE [pay in full]

Business Information

The Laura Aura
ABN: 31 120 587 240
69 Boollwaroo Parade
SHELLHARBOUR , NSW , 2529
Australia
hello@wollongongwomen.com.au
0402101808

Plan details for LEVITATE [pay in full]

By completing the form below, you agree that The Laura Aura will securely store your payment details on file and will charge you automatically when a payment is due.

You also acknowledge that you have read the Terms and Conditions by clicking here.

Amount	Description	Debit Schedule
AUD 999.00	Pay in full amount for Levitate Program	Immediately

How would you like to pay?

Credit / Debit Card ( Processing fees apply )

Bank Account ( Processing fees apply )

Payment processing fees will apply

Domestic Card Fees
American Express	2.50% + $0.30
Visa / Mastercard	1.95% + $0.30

International Card Fees
American Express	3.90% + $0.30
Visa / Mastercard	3.90% + $0.30

Credit Card Details

All fields are required unless marked as optional.

Company Name (Optional)

First Name

Last Name

Address Line 1

Address Line 2 (Optional)

City

State

Postcode

Email Address

Card number (no dashes or spaces)

Security Code

Exp. Month

Exp. Year

Name (as it appears on your credit card)

**Please ensure that your invoice payments are kept up to date to avoid financial penalties or further action including debt collection.

Payment processing fees will apply

Domestic Bank Fees
Direct debit	1.00% + $0.30

Bank Account Details

All fields are required unless marked as optional.

Company Name (Optional)

First Name

Last Name

Address Line 1

Address Line 2 (Optional)

City

State

Postcode

Email Address

BSB Number

Account Number

Bank Account Name

**By entering this agreement, you approve The Laura Aura to debit the nominated bank account above.

By submitting you acknowledge that you have read the Direct Debit Request Service Agreement by clicking here. A copy of the DDRSA and your completed DDR will be emailed to you for your records.