MineX 2019The Buffs Club Tab - Credit Card Authorisation Form

I hereby authorise Carpentaria Buffalo Club trading as The Buffs Club Mount Isa to charge the below credit card for the tab amount consumed throughout the duration of MineX 2019 (May 29 to June 1) on behalfof the below listed company or person(s).

The Buffs Club will allocate a card for you to hand to staff in order to access the tab.

This tab can cover all food and drink purchased from The Buffs Club (only) during the event days incl. the Bufs Coffee Shop on-site at the Expo, the Drinks in Trade Networking Function bar and the MineX Rocks Closing Concert VIP Bar as selected below. Note- Public Bar at MineX Rocks will not have tab access however eftpos will be available fromdrink ticket desk. Gala Opening Function tabs to be separate due to different suppliers

The total tab accrued will be charged to your credit card on Monday June 3, 2019 and you will be sent a tax invoice to the email listed below once this charge has been finalised.

Company Details

Company/Individual Name: ___________________________________________________________

Tab No: _______

Phone: _________________________________ Email: ___________________________________

Credit Card Details

Card type: ___________________________ Card Number: _________________________________

Name on Card: _____________________________ Expiry: _____________ CCV: ______________

Declaration

I ___________________________ authorise Carpentaria Buffalo Club to charge the credit card listed above

and confirm that I fully understand my obligations and responsibilities as outlined. I hereby fully indemnify

The Buffs Club from any liability which may occur as a result of receiving false or misleading information. Or

which may occur as a result of mine or any of my associates failure to fulfill my obligations above.

Signature __________________________________________ Date _________________________

Amount? ______________________ Tab Limit? Yes No

Tab Cover: Expo Coffee Shop Catering Drinks in Trade Networking Function Bar

MineX Rocks VIP Bar

Please list any special conditions? ___________________________________________________

Forms to be returned via email accounts@buffs.com.au prior to the event or in person to the Expo Coffee Shop at MineX

(Office Use Only)

Please select those applicable