Application form

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The eligibility age for applying for an
ACT Seniors Card is 60 years.
Click here to go to the application form.

ACT Seniors Card Discount Directory Business Application Form

Business Details to be published in listing

Legal entity name

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ACN or ABN

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Trading Name for publishing(*)

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Licence No. if applicable

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Contact email for publishing

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Contact phone for publishing

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Street Address

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Website

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Facebook page

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Instagram page

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Twitter page

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Business category(s)
- hold cmd or alt key to select multiple(*)

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Suggested other category

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Proposed discount or value-added offer(*)

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Please note that participation in the ACT Seniors Card Program automatically involves offering the same discounts to interstate Seniors Card holders and NZ Gold Card holders.

Are multiple outlets participating?

No Yes Invalid Input

Outlet names and addresses

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Listing Type

Listing type(*)

Text entry only (FREE) Text entry with logo ($250 p.a.)Text entry with online banner for 3 months ($750)Text entry with online banner for 12 months ($2,500)

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Choose logo file to upload

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Banner art upload

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Administrative contact for COTA

Contact name for admin(*)

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Contact phone for admin(*)

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Contact email for admin(*)

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Seniors Card promotional material required

Adhesive window decalCounter stand Invalid Input

International Cards

Is the offer available to all International Seniors Card holders?

Yes No Invalid Input

By submitting this application, you agree to the ACT Seniors Card Terms and Conditions. You may also download a PDF copy of these Terms and conditions here.

Submit your application

(*)

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Hughes Community Centre,
Wisdom Street, Hughes
(next to Hughes shopping ctr)

(02) 6282 3777

Home
Eligibility
FAQs
Interstate Travel
Government Services
Discount Directory
Business Opportunities
- Application form