New Supplier Application
Company Name
*
ABN
*
Registered for GST?
*
Yes
No
Business Address
Street Address
Street Address Line 2
Suburb
State
Post Code
Main Contact Name
First Name
Last Name
Main Contact Email
*
example@example.com
Secondary Email (Accounts, Invoices, Work Orders)
example@example.com
Main Phone Number
Please enter a valid phone number.
Format: 00 00000000.
Secondary Phone Number
Please enter a valid phone number.
Format: 00 00000000.
Services Provided
Contact Details (for repairs and maintenance requests)
if different to above
Contact Name
First Name
Last Name
Email
example@example.com
Mobile Number
Please enter a valid phone number.
Format: 0400 000 000.
Bank Details
Account Name
BSB
Account No.
Insurance Details
Public Liability - Limit of Cover
Public Liability - Expiry Date
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Certificate of Currency - Public Liability
*
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of
Worker's Compensation (or Personal Accident cover)
Please Select
Yes
No
Worker's Compensation Expiry Date
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Certificate of Currency-Worker's Compensation/Personal Accident
*
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of
Licensing
Licence Type / Class
*
Licence Number
*
Licence Expiry
*
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Comments
Confirmation
As an authorised person for the above mentioned business, I confirm:
*
All information supplied is true and an accurate reflection of the business I am the authorised person. I understand that if are any changes to insurance policies and/or licensing of the business, we will immediately inform Metro Strata Management Pty Ltd.
Name of Authorised Person
*
First Name
Last Name
Authorised Person Title
*
Signature of Authorised Person
*
Submit
Should be Empty: