Please Tick Services Required

SERVICES BOOKING FORM
Consignor / To:
Company / SCHENKER AUSTRALIA PTY LTD
Street / 72-80 Bourke Road
Suburb / Town / Alexandria (Sydney) NSW 2015
Phone No. / +61 2 93330418
Fax No. / +61 2 93330470
Email /
Contact Person / Greg Northcott
AU and NZ Nephrology 49th Annual Scientific Meeting
8th – 11th September 2013
Brisbane Convention Centre
Pick up address
(if different from above)
Goods available for collection / Date / Time
Cargo measurements and weights / No. of pieces/ units / Type of unit (carton, pallet, crate, etc) / Weight (kgs) / Length (cms) / Width (cms) / Height (cms)
Cargo description / Commodity / Dangerous goods / Quantity / Value (AUD)
Yes No
Yes No
Yes No
Yes No
Yes No
Delivery to venue
Location on site / Hall / Stand no / Delivery on / Date / Time

Please tick services required

Domestic road freightForklift

Domestic rail freightCrane

Domestic air freightLabour

Others, please specify: Est. time required:

Credit Card Details

Card Number
Expiry Date / Master Card / Charge Card
Security Code / Visa / Security Only
Card Surcharge / . / % / Amex

Amount in AUD ______

Cardholder’s Name:______Cardholder's Signature: ______

Please finalise Schenker Australia Pty Ltd’s invoice within 7 days of issuing date otherwise above credit card will be charged. I understand that the above details provided will be used for the invoiced debt of the company.

The cardholder confirms and acknowledges that it hereby irrevocable guarantees the full and prompt payment of all fees, invoices or charges of the above referenced Company and that in case of Company default or delay in making payment on any such fees, invoices or charges, the Cardholder can be held personally liable for which the above referenced credit card can at any time be debited by Schenker in the full amount of any outstanding Company fees, invoices or charges.

If such credit card is at the time of debiting null and void, lacking available funds or declined for any reason by the relevant banking or credit institution, the Cardholder acknowledges that a claim on or against the cardholders personal goods and/or property may be required as security pending full settlement of Company payments.

The customer acknowledges that any carriage and any operations and services offered by SCHENKER AUSTRALIA PTY LTD and/or by any of its subcontractors are offered on the basis that SCHENKER AUSTRALIA PTY LTD is not a common carrier and that such carriage, operations and services are undertaken subject only to the Trading Conditions which are available on request.

ACCEPTED BY CUSTOMER (name print / signature) / DATE