Power Buy Coupon

Select Offer *

Purchase Date *

Total sale value of elibible products (ex GST)

Reciept #

Salesperson

Has the customer paid for the product? Pending payments must be confirmed with PowerBuy before a rebate is paid

Yes

Ask your customer "Did this cash-back offer assist with your purchase decision?"

Yes

Email * If your customer is an existing PowerBuy member, enter the same email address they registered with

First Name *

Last Name *

Company Name *

ABN (optional)

Address *

Suburb *

State *

Postcode *

Method of payment We store all account details in an encrypted format for your customer's security

Prefer Direct Deposit

Prefer Cheque

BSB

Bank Account Number

Bank Account Name

Claim Notes