Application for Site Access

APPLICATION FOR RENEWAL OF ACCESS TO PERTH MARKET

TO BE USED FOR RENEWALS ONLY
PERSONAL DETAILS
NAME*

First NameLast Name
MOBILE PHONE NUMBER*
Must be an Australian Mobile Number
EMAIL (THIS WILL BE USED TO ISSUE YOUR ACCESS CODE AND SHOULD BE PERSONAL TO YOU, THE APPLICANT, AND NOT A SHARED MAILBOX)*
example@example.com
ADDRESS*

Street Address

Street Address Line 2

CityState

Post CodeCountry
REASON FOR ACCESS
ACCESS STATUS*

TENANT / TENANT EMPLOYEEBUYERTRANSPORT (Strictly NO onsite parking)GROWER / SUPPLIER
BUYERS ONLY
BUYER CODE
EMPLOYER / COMPANY
EMPLOYER / COMPANY NAME*
INDUCTIONS

Forklift Induction Refresher
PLEASE VISIT WWW.PERTHMARKET.COM.AU/INDUCTIONS AND COMPLETE THE FORKLIFT OPERATORS PERMIT INDUCTION

Use of a Forklift on Site without a valid and current and valid High Risk Licence and PMG Forklift Permit may result in your access to site being suspended.
Site Safety Induction Refresher
I HAVE WATCHED AND UNDERSTAND THE SITE SAFETY VIDEO

YESNO
TENANT / TENANT EMPLOYEE

PLEASE CHECK WITH YOUR EMPLOYER REGARDING AVAILABE PARKING ON SITE CURRENTLY ALLOCATED TO THEM.

(Vehicle access to Perth Market may not be granted until a parking bay has been purchased and allocated)
CONFIRMATION
THE APPLICATION FEE IS PAYABLE ON THE ACCEPTANCE OF THIS APPLICATION AND PRIOR TO THE ISSUE OF PERTH MARKET MOBILE CREDENTIALS / PMGL FORKLIFT PERMIT. MOBILE CREDENTIALS WILL BE ACTIVE AND CAN BE USED TO ENTER THE PERTH MARKET SITE FOR A PERIOD OF 12 MONTHS. AT THE END OF THE 12 MONTH PERIOD, AN ANNUAL RENEWAL FEE WILL BE DUE. FAILURE TO RENEW THE MOBILE CREDENTIALS WILL RESULT IN EXPIRY AND ACCESS WILL BE WITHDRAWN. FORKLIFT PERMITS ARE VALID FOR 12 MONTHS OR THE DATE OF EXPIRY OF THE HIGH-RISK WORK LICENCE, WHICHEVER IS FIRST.

MOBILE CREDENTIALS / PMGL FORKLIFT PERMITS MUST BE CARRIED AT ALL TIMES.

PERTH MARKET IS A DRUG AND ALCOHOL FREE SITE. DRUG AND ALCOHOL TESTING (SCREENING) IS CONDUCTED ON SITE. BY ENTERING THE PERTH MARKET, YOU AGREE TO COMPLY WITH THE DRUG AND ALCOHOL POLICY AND AGREE TO ALCOHOL AND DRUG SCREENING. FAILURE TO COMPLY WITH THIS POLICY MAY RESULT IN REFUSAL TO ENTER OR REMOVAL FROM SITE.

YOU ACKNOWLEDGE, AS PER CONDITIONS OF ENTRY, THAT REMEDIAL ACTIONS ARE AVAILABLE TO PMGL IN ORDER TO MINIMISE THE RISK OF LOSS, DAMAGE, DEATH OR INJURY BEING SUSTAINED BY PERSONS OR PROPERTY, AND TO PROMOTE THE SAFE, EFFECTIVE AND EFFICIENT OPERATION OF THE SITE. YOUR SIGNATURE BELOW INDICATES YOU HAVE RECEIVED, REVIEWED AND UNDERSTOOD PERTH MARKETS SITE SAFETY INFORMATION AND SITE RULES. YOU AGREE TO AND ACCEPT THE CONDITIONS OF ENTRY TO THE SITE AND PERTH MARKETS GROUP PRIVACY POLICY. FAILURE TO OBSERVE THE SITE RULES MAY RESULT IN CANCELLATION OF THIS ACCESS.
I HAVE READ, UNDERSTAND AND AGREE TO THE ABOVE CONDITIONS*

YESNO

I CONFIRM THE INFORMATION SUPPLIED IS TRUE AND CORRECT*

YESNO
SIGNATURE*

Clear
PRINT NAME*
---- PMG OFFICE USE ONLY ----
PAYMENT AMOUNT
PAYMENT TYPE

ON LINECASHEFTPOSINVOICE
RECEIPT / INVOICE NUMBER
PLEASE CONFIRM (CHECK ALL THAT APPLY)

PAYMENT RECEIVEDID SIGHTEDMOBILE CREDENTIAL ISSUEDDIGITAL ID ISSUEDEXPIRY DATE SET
ENTERED AND PROCESSED BY
Name
DATE

DayMonthYear
Date
Should be Empty:

CREDIT CARD DETAILS
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

APPLICATION FOR RENEWAL OF ACCESS TO PERTH MARKET

PERSONAL DETAILS

REASON FOR ACCESS

BUYERS ONLY

EMPLOYER / COMPANY

INDUCTIONS

PLEASE VISIT WWW.PERTHMARKET.COM.AU/INDUCTIONS AND COMPLETE THE FORKLIFT OPERATORS PERMIT INDUCTION

CONFIRMATION

---- PMG OFFICE USE ONLY ----