Payment Plan Application Form Name* First Last Email* Phone Number*Zazen Alkaline Water Filter OptionsBPA Free TankGlass TankShipping*Brisbane MetroGold Coast, Sunshine Coast & IpswichSydney MetroCentral Coast NSW & ACTTweed Heads & CoolangattaMelbourne MetroGeelong & VIC CountryAdelaidePerthTasmaniaNon-Standard AreaPrices are effective from 19th November 2018, as per Australia Post price increase in September 2018. Non standard areas, (as defined by Australia Post), will be calculated per order, due to the geographic area being too large for a standard freight price.Total $ 0.00 Payment Plan Schedule*WeeklyFortnightlyMonthlyPayment Plan Amount*$50$60$75$100Other AmountDeposit Amount*Please nominate the amount of deposit you would like to pay; minimum is 10%.Message*If you cannot find a payment schedule or amount that suits your needs please nominate your own option here, or any other information you think may be necessary.Consent* I agree to a customised payment plan being created for my purchase, through PayPal's Subscription Service.This is a contract between Sanctuary for Souls, Great & Small, and the person nominated in the attached form. The payment plan will be set up as a subscription service through PayPal. The plan will be customised to your requirements as nominated in the form. You can choose weekly, fortnightly or monthly payments and you can nominate how much deposit you want to pay, as well as the subscription payment amount. No interest is charged during the payment period, however a small fee of 2.9% is charged to cover the PayPal fees.CAPTCHA This iframe contains the logic required to handle Ajax powered Gravity Forms.