Membership Form

This is a Secure Form. You may safely provide your details online.
However, if you prefer, you can fill out a printer friendly form
and fax to (02) 9369 1955 or send it to:
Coffee Days, Reply Paid 165, Double Bay NSW 1360

membership Size
Single – 400g per month, enough for 40-50 cups, $27.50 per month
Double – 800g per month, enough for 80-100 cups, $47.50 per month
Small Office – 2kg per month, enough for 200-250 cups, $74.50 per month

Grind Preference:
First Name:
Delivery Address:
Delivery Instructions:
Please provide instructions for the delivery person in case your coffee doesn’t fit in your letterbox or nobody is home. This is very important as you may need to pick the coffee up from the post office if the package cannot be delivered securely.

Gift membership

(If membership is a gift, please provide details of the
gift giver):


Where/how did you find out about Coffee Days?
Promotion Code:
(If you have a Promotion Code, please enter it here)

Payment Details
Pay by the Month
  (Conveniently charged to your credit card every month)
Prepay for months, total $

Credit Card Details:
Card Type:
Card Number:
Expiry Date:
Name on Card:
Date of Birth
(For security reasons)

Terms and Condition
By completing and submitting this application form, you authorise Coffee Days to charge your credit card for the membership detailed above. Pay by the month memberships will be charged to your credit card when each shipment of coffee is dispatched. Coffee shipments will be sent to you every month unless and until you advise Coffee Days to suspend or cancel your membership. You can suspend or cancel your membership at any time by contacting Coffee Days by mail, email or phone. Please allow five working days for suspensions and cancellations to take effect. Customers will be given ample notice of any changes to the cost of memberships. Coffee Days reserves the right to suspend or cancel memberships at its discretion for reasons including dishonoured payments and abuse of the Money Back Guarantee.

Coffee Days’ Privacy Policy is displayed on its web site.

I accept the terms and conditions