Student Enquiries Order Form

Your Details

Title

First Name

Last Name

Organisation

Website

Telephone

Fax

Email for invoice

Address

City

State

Postcode

Country

Click here if your billing details are different to those listed above

Hide Billing Address

Billing Address

Billing City

Billing State

Billing Postcode

Billing Country

Order Details

ABN (if in Australia)

Purchase Order number (if needed):

Are you renewing a currently active EdMedia campaign?

Yes No

Please send my invoice via:

Email Fax Post

Are you completing this form yourself?

Yes No

Which EdMedia representative introduced you?

Comments or requests

Production Selection

Package

2000 Enquiries 1500 Enquiries 1000 Enquiries 800 Enquiries 600 Enquiries 500 Enquiries 400 Enquiries 300 Enquiries 200 Enquiries

Package Rate (AU$) inc. activation fee

16,000
13,500
9,750
9,100
8,100
7,050
6,100
4,850
3,500

Surcharges apply if you wish to block students in more than 20% of countries from making enquiries.

Percentage of countries to decline

0 - 20% decline = 0% surcharge 21 - 40% decline = 10% surcharge 41 - 60% decline = 20% surcharge 61 - 80% decline = 40% surcharge 81 - 90% decline = 50% surcharge

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