Online Request for Haoyah Start-Up Kit Personal Details Title: Given Name: Surname: Dr Mr Ms Mrs Miss I would like to receive forms by: Fax:     Email:  (Forms sent via email will be in PDF format) Post: Please complete the details below: Address: Suburb:  State:    Post Code:  Country: Phone Number: Number:    I would like the following form(s): Full Sign-Up Kit Warrants Trading Straight Through Processing Broker to Broker Options Trading Third Party Authority Form Issuer Conversion Form Common Fund Prospectus Electronic Contract Note Activation Where did you hear about our services? Newspapers The Australian Financial Review Melbourne Age Sydney Morning Herald West Australian Sun Herald Magazines Shares Personal Investment BRW Inflight (Qantas or Ansett) Electronic Media Television Radio Internet E-mail Other Word of Mouth Trade Show ASX Billboard