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WESTERN UNION GOLD CARD APPLICATION FAX US YOUR COMPLETED ENROLMENT FORM 1. DOWNLOAD the Enrolment Form 2. SEND the form to Western Union Financial Services Australia Pty Ltd Reply Paid 625 Queen Victoria Building NSW 1229 To ensure you maximise the bene ts of the Western Union Gold Card simply complete all the details outlined on this application form. When you receive your Western Union Gold Card you ll be able to use your card to access the details of the recipients you have entered onto this form. Your Information Please use CAPITAL LETTERS and ENGLISH CHARACTERS when lling out the form. MANDATORY elds are identi ed with an asterisk. TYPE in the spaces provided 3. PRINT off the completed form 4. FAX the completed form to 02 9226 9111 SEND US YOUR COMPLETED ENROLMENT FORM 4. Salutation Mr Mrs Miss Ms First Name s Last Name Address City/Suburb Home Tel No* State Postcode Mobile Phone Email Address Language Preference Receiver s Information the person you send Money to Country Telephone No* Call 1800 501 500 to load additional Receivers. Open to perons 18 years of age and older with a valid Australian address. Western Union may use your personal data from this form to provide you with further information about the services of Western Union and the services of other trusted third parties. Salutation Mr Mrs Miss Ms First Name s Last Name Address City/Suburb Home Tel No* State Postcode Mobile Phone Email Address Language Preference Receiver s Information the person you send Money to Country Telephone No* Call 1800 501 500 to load additional Receivers. Open to perons 18 years of age and older with a valid Australian address. Western Union may use your personal data from this form to provide you with further information about the services of Western Union and the services of other trusted third parties. .

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