The fees are affordable and a discount is provided for 2 and 3 year registrations:
One year: $100 plus GST Two years: $170 plus GST (ie: effective cost of $85 per year) Three years: $228 plus GST (ie: effective cost of $76 per year)
The registration fees are used to fund the system, including the 6-monthly telephone check with the carers of registered clients to ensure that all information is kept up to date.
Registration Period and Cost Cost (inc GST) One year: $110 inc. GST Two years: $188 inc. GST Three years: $252 inc. GST SUBTOTAL A Bracelet Code Number (refer to description sheet) Inc. GST QTY Cost (incl GST) Ladies Medilog (2124 SS) $33 Ladies Medilog (2124 GP) $55 Men’s Medilog (1102 SS) $47 Men’s Medilog (1102 GP) $73 Ladies’ flexible band with compartment (711 GP) $55 Men’s flexible band with compartment (1024 GP) $63 Pendant/Neckchain (1164 SS) $40 Engraving Cost per Bracelet $16 Desired first name on Bracelet: eg. “Jim” SUBTOTAL B $ Postage & Handling Cost for Bracelet $10 $ SUBTOTAL C $ GRAND TOTAL (Subtotal A + B + C) (registration + bracelet + postage & handling ) $
Payment Options
Please select your preferred method of payment and fill in the relevant details on the payment form below. Cheques or money orders made payable to: “Safe Return Home” Applied Aged Care Solutions.
*The Safe Return Home registration fees have been set for those using Cheques, Money Orders or Electronic Direct Debit (eg. from Commonwealth Bank NetBank). We are absorbing the credit card transaction charges we incur from the credit providers.
Payment by Credit Card
Card No:
Card expiry date: _ _ /_ _ /_ _
Cardholder Name: __________________________
Amount authorised for payment: $____________
Cardholder Signature: _______________________
payable to: “Safe Return Home” Applied Aged Care Solutions.
Cheque No:
Drawer: ____________________________________
Total Payment: ______________________________
Payment by Electronic Funds Transfer / Electronic Direct Debit
to Account Number: BSB: 063 222 Account number: 1020 2809
Date: _ _ /_ _ /_ _
Please attach or fax or post the bank receipt if possible
Billing Contact
Contact listed on registration form: Primary Carer Contact 1 Contact 2 Contact 3
If not a previously listed contact, please provide details below:
First Name:................................................................................ Surname:................................................................................ Home Phone Std: ( ) Work Phone Std: ( ) Mobile:................................................................................................ Email Address:.................................................................................... Street Address & Number:.................................................................. Suburb:.............................................................................................. Post Code:......................................................................................... State:.................................................................................................
1. Complete the Registration Form (Essential and/or Extras) 2. Include Bracelet Details (if required) 3. Complete the Consent Form (required for registration) 4. Include Photo/s 5. Send Completed Forms to:
Safe Return HomeApplied Aged Care SolutionsPO Box 4088Balwyn East Melbourne, Victoria 3103
OR
To pay by phone, free-call 1800 11 22 01Please have your registration and credit card details ready before making the call.
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