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 ___________________________