PRIVATE TREATY WOOL MERCHANTS of AUSTRALIA INC

ABN: 44 672 992 152

Unit 9, 42-46 Vella Drive, Sunshine West Vic 3020

Tel: 03 9311 0103 Fax: 03 9311 0138

www.woolindustries.org/ptwma.htm

Company Name:

Month:

ABN:

A) First Hand Taxable Wool Bought Privately:

Levy Payable On Above @ 16.5c Per Bale :

(please round total to nearest whole cent)

*The total levy includes GST payable by PTWMA

$ *

B) Wool Bought Privately From Non-PTWMA Members : (tax already paid)

Total Number Of Bales (A + B):

PAYMENT DUE AT THE END OF MONTH

PLEASE NOTE CHANGE OF CONTACT DETAILS

If paying electronically, please fax or email remittance advice on day of payment

to Melissa Mulley on 03 9311 0138 or

melissa.mulley@woolindustries.org

If you require banking details please

contact Melissa Mulley on 03 9311 0103

If paying by cheque, please print this form and

remittance and send to:

PTWMA

SUNSHINE WEST VIC 3020

IMPORTANT: Please Print This Form For Your Accounts Department Before Clicking Submit.