Warning: mysql_pconnect() [function.mysql-pconnect]: Access denied for user 'jess2'@'localhost' (using password: YES) in /home/jess2/public_html/mandate/mysql_inc.php3 on line 25

Welcome to QLD's Remove the GST Mandate Form.

Please complete the details on this form and press the Submit button on the bottom of the form to submit your entered details for processing.  You will then be presented with the Mandate Form completed with the details that you entered in this form.  Just print the page displayed in your browser to your printer on "Plain White Photocopy A4 Paper".  Then sign the form at the two locations indicated by "Signature" and mail it to the address on the bottom of the Mandate Form.

Please access the Mandate Completion Guide by pressing this button which will open a window on the top left of your screen with instructions on how to setup your browser to be able to printout the Mandate Form with minimal effort. Please use it to determine what to do at the various steps while you are completing the Mandate Form.


Title   eg (Mr, Mrs, Miss, Ms etc)
First Name   eg (John)
SecondName   eg (Simon, Steven, John, or leave as -- )
Surname   eg (Smith)
DateOfBirth - -   eg ( DD - MM - YYYY ) sample ( 23 - 06 - 1953  )
Email:   eg ( youremail@yourisp.com.au )
If you don't have an email address get a free Web Based Email Address NOW. Then come back here and complete this form.

Address Details:-

StreetPrefix Street# StreetName StreetType
Unit, Lot, House, Property, etc
OPTIONAL
12, 12/123, 48-64, etc Coronation, Pacific,  Queen, Paramatta, George, etc St, Ave, Crt, Cir, Plc, Lne, Drv, Hwy, Rd, etc.

Suburb Postcode State State Electorate
Your QLD based Suburb. Your QLD based postcode. Your state of QLD is preselected when you chose the QLD Mandate form. Select your QLD State Electoral division.

Local Council or Shire Federal Electorate
Select your QLD Local Council, Shire or Municipality. Select your QLD federal electorate.