Disclosure Statement Request Form

• Lot #
• CTS #
• Owners Name^*
• Property Name
• Property Address
• Phone
• Mobile
• Fax
• Email^*
• Disclosure Faxed to:
• Disclosure Posted to:

• $120.00 FOR NEXT DAY SERVICE, AFTER RECEIPT OF PAYMENT OR
• $165.00 FOR SAME DAY, AS RECEIPT OF PAYMENT

Please note proof of payment is required prior to Capitol processing your Disclosure Statement request. Proof of payment can be emailed to the Capitol accounts team via team@capitolbca.com.au.

• Bank Transfer MACQUARIE BANK LIMITED, BSB: 184-446, A/C: 2237 71528
• Pay by Credit Card or PayPal You will be directed to a PayPal payment once completing form
• ** Please note that when paying by PayPal an additional charge of 2.4% and 30 cents per transaction will be incurred. These rates are subject to change by the Financial Insitution.

• I UNDERSTAND THAT THE FEE FOR A DISCLOSURE STATEMENT IS $120.00 (NEXT DAY) OR $165.00 (SAME DAY) AND THAT THE STATEMENT WILL BE PROVIDED AS A NEXT DAY SERVICE AFTER RECEIPT OF PAYMENT AND THAT ADDITIONAL CHARGES APPLY WHEN PAYING BY CREDIT CARD.
• Notes
• Enter Code:^*
•