You are now connected to our secure server, indicated by a padlock in the status bar of your web browser.

Please note that you must be over 18 to join Video Anytime via our web site. However, you may allow additional card users under the age of 18 access to dispensers via the minors PIN.

You must read and agree to the Terms and Conditions before applying for membership.

Personal Details
Title:
First Name: *
Last Name: *
Birth Date:
Address (Line 1): *
Address (Line 2):
Suburb: *
State: *
Country:
Postcode: *
Home Phone: *
Mobile Number:
e-Mail Address: *

Please ensure you provide a valid e-mail address, as this will be used to notify you of changes to your application status.
Identification Type: (Photo ID with current address is required) Drivers License
Passport
Other. Please Specify
Q: What if I do not have photo ID showing my current address?
A: If you do not have photo ID, you may still apply by providing some form of ID such as a drivers license along with a current utility bill showing your current address.
Identification Number: (i.e. Drivers License number, Passport Number)
Credit Card Details: (Must be in name of applicant) We accept Visa, MasterCard and BankCard.
Credit Card Number:
Credit Card Expiry:
Name on credit card:
Pre-charge credits: If supplying credit card details, you may also wish to pre-charge your membership card. Simply tick the box below and your membership card will be pre-charged with $20 via the supplied credit card. We will also give you an additional free $5 bonus credit ($25 total balance). Note: Bonus credits expire 7 days from first use.
Yes, please charge $20 to my credit card.
Q: Why do I need to provide credit card details?
A: Your credit card details affect the maximum goods you may rent at one time. Your credit card is only used in case of non-return of product or non-payment. If you are unable or do not wish to provide credit card details you may still apply for membership, however our dispensers will not allow more than 1 item to be rented at a time.
Store and Membership Card Details
You must choose the 4 digit PIN(s) on your membership card, used for secure access to dispensers. Each card features two PINs, a Master PIN for full unrestricted access, and a second Minors PIN for allowing those under 18 access only to suitable titles (blocks access to R rated titles). The Minors PIN must not be the same as the Master PIN, but may be left blank if not required.
Store Location:
Master PIN: * (For full access to dispensers)
Minors PIN: (For restricted access, blocks R rated titles)
Formats Used: VHS DVD Playstation Playstation 2
X-Box GameCube PC Games
Confirmation
I confirm that I am at least 18 years of age and that all the information I have provided is true and complete and that I have read and accepted the terms and conditions. I also agree that submitting this online application does not automatically provide me with membership, and that Video Anytime must sight my Proof Of ID (and Credit Card if provided) before approving my application.