Add a Site to your LRA Membership

For existing members · $20 +GST a month per additional site · same legal entity · maximum 4 sites in total

Additional site request received

We've received your request to add a site to your LRA membership. We'll confirm it and set up the additional $20 +GST monthly debit.

A copy has been emailed to you for your records.

membership@localretailers.com.au
02 9978 3400

Your existing membership

Additional sites must operate under the same legal entity as your primary LRA membership. A membership may cover a maximum of 4 sites in total, including the primary site.

Legal entity name — must match your primary membership

ABN — must match your primary membership

Primary site trading name

Your LRA membership/reference number — if known

New site(s) to add

How many sites are you adding on this form?

Remember: 4 sites maximum in total, including your primary site.

Site 1 — trading name

Site 1 — full address

Site 1 — phone

Site 1 — email

Site 2 — trading name

Site 2 — full address

Site 2 — phone

Site 2 — email

Site 3 — trading name

Site 3 — full address

Site 3 — phone

Site 3 — email

Contact

Contact name

Mobile

Direct debit — additional charge

I/WE authorise Local Retailers Australia to debit our existing nominated account for the additional $20 +GST per month, per site added above.

This applies to the same bank account already used for your LRA membership. If your account has changed, note it below.

Account change note — only if your bank details have changed

I authorise the additional monthly debit for the site(s) above

Declaration

Full name (authorised signatory)

Date

I confirm these sites operate under the same legal entity as my primary membership (4 sites maximum in total), and I accept the LRA Membership Terms & Conditions, including affiliate membership of the Australian Newsagents’ Federation