LRA Membership Application

$70 +GST a month ($49 reduced rate if eligible) · initial 12-month period · direct debit set up internally

Application received — welcome to LRA

Your completed application has been sent to our membership team. We'll confirm your membership and set up your direct debit.

A copy has been emailed to you for your records. It includes the full terms and your acceptance record, but not your bank details.

Questions in the meantime?

membership@localretailers.com.au
02 9978 3400

Primary business

Trading name

Legal entity name

ABN

Owner(s)

Trading address

Suburb

Postcode

State

Contact

Contact name

Telephone

Mobile

Your store

Tick if you are a new business/owner

Estimated settlement date

Additional sites you're adding now — same legal entity only; maximum 4 sites in total including this one. Each additional site is $20 +GST a month.

Additional site 1 — trading name

Additional site 1 — full address

Additional site 1 — phone

Additional site 1 — email

Additional site 2 — trading name

Additional site 2 — full address

Additional site 2 — phone

Additional site 2 — email

Additional site 3 — trading name

Additional site 3 — full address

Additional site 3 — phone

Additional site 3 — email

All additional sites must operate under the same legal entity as your primary business, up to a maximum of 4 sites in total.

Membership options

Applying for the reduced $49 +GST rate? — card turnover under $120k/month; recent merchant statement required

Recent merchant statement — PDF or photo, under 2.5 MB

How did you hear about LRA?

Direct debit request

Bank account name

BSB

Account number

I/WE authorise Local Retailers Australia to debit the nominated account on a monthly basis.

I agree to this Direct Debit Request

The first drawing will be debited at the next draw cycle. Membership is for an initial 12-month period.

Declaration

Full name (authorised signatory)

Date

I accept the LRA Membership Terms & Conditions, including admission as an affiliate member of the Australian Newsagents’ Federation and the Direct Debit Request Service Agreement