[icon class="fa-solid fa-hand-holding-dollar"] Mastercard or direct deposit into your bank account

Service Request - Request for funds

Member title

Phone/Mobile

Mailing Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

We in our capacity as trustee of our estate, RRDJ number

Request we be provided with the following sum

via

Gift Card(s) - 1 card equals 1000 credits

Bank Transfer

Account Holder

BSB

Account No

We understand and accept that this is a lifetime loan and could be called back at the Steward’s discretion.

We direct the Steward to charge any of our assets in the registry as security for this amount.

Given this day by our hand and sign:

The tick in this field signifies my signature.

Date

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