Contractor Account Application
Welcome to the Mars Projects team!
MARS REPRESENTATIVE
Who is your Mars contact?
*
Please Select
Anthony Khoury
Daniel Cejas
Terry Gav
Tilbe Selim
William De Barros
Marcelo Pinheiro
Corey Di Fabio
Luca Lopes
COMPANY DETAILS
Full Company Name
*
Trading As Name (if applicable)
ABN
*
Company Address
*
Street Address
Street Address Line 2
City
State/Territory
Post Code
COMPANY CONTACT DETAILS
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Website
ACCOUNTS INFORMATION
Name
*
First Name
Last Name
Accounts Email
*
example@example.com
Accounts Phone Number
*
BANK INFORMATION
Account Name
*
BSB
*
Account Number
*
INSURANCE DETAILS
Public Liability Insurer
*
Public Liability Policy Number
*
Public Liability Expiry Date
*
/
Day
/
Month
Year
Date
Attach Public Liability
*
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of
Workers Compensation Insurer
*
Workers Compensation Policy Number
*
Workers Compensation Expiry Date
*
/
Day
/
Month
Year
Date
Attach Workers Compensation
*
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of
Professional Indemnity Insurer (if applicable)
Professional Indemnity Policy Number
Professional Indemnity Expiry Date
/
Day
/
Month
Year
Date
Attach Professional Indemnity
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Choose a file
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of
SIGNEE INFORMATION
Name
*
First Name
Last Name
Email Address
*
example@example.com
Position
*
Phone Number
*
Signature
*
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