Inner West Business Enterprise Centre : Member's Form

For ONLY $55 a year (incl. GST) you can become a part of the Inner West Business Enterprise Centre and support an association that supports small business.

Plus the assurance of knowing you are assisting businesses in the Inner Western area.

Please fill out the form below if you wish to become a member of the Inner West Business Enterpise Centre.

Our order form encrypts the information you send, ensuring the safety and confidentiallity of your details.

* = required

Given name *

Surname *

Position *

Business name *

Address *

Suburb *

Postcode *

Telephone *

Mobile

Fax

Email *

Name on Credit Card *

Credit Card Number *

Expiry Date (mm/yy) *

Card Type *

Provide us with a short profile (20 words) of your business *

Provide us with 7 Keywords for our search engine *

Contact person *

Website address

Phone (Optional)

Fax (Optional)