NDIS Supplier Directory Application Form

NDIS Supplier Directory Application Form

Apply to become a listed partner in the NDIS Supplier Directory by Tania Gomez Consulting. Please complete all sections below to help us assess your suitability.
Business Details
Business Name*
ABN (Australian Business Number)*
Main Business Address*

Street Address

Street Address Line 2
CityStatePostal / Zip Code
State

NSWVICQLDWASATASNTACT
Website URL
Primary Contact Name*

First NameLast Name
Position Title (Primary Contact)*
Email Address*
Business Phone Number*
Format: 0000000000.
Mobile Number*
Format: 0000000000.
Social Media Account
Type the URL of your main social media page.
About Your Organisation
Business Overview*
Please describe your organisation, who you serve and what makes your service valuable to NDIS providers. (150–200 words). This will appear on the website listing page.
Year Established*
Number of Employees*
Category Selection
Please select the single category that best represents your core offering.*

Technology and Software SolutionsWorkforce and HR SupportTraining and Professional DevelopmentInsurance and FinanceMarketing, Branding and Digital ServicesEvents and NetworkingSpecialist Provider Support ServicesBusiness coachingAudit and complianceAllied Health providersBehaviour Support PractitionersOther NDIS Provider TypeOther (please specify)
Please select the category that best represents your core offering.*

Technology and Software SolutionsWorkforce and HR SupportTraining and Professional DevelopmentInsurance and FinanceMarketing, Branding and Digital ServicesEvents and NetworkingSpecialist Provider Support ServicesBusiness coachingAudit and complianceAllied Health providersBehaviour Support PractitionersOther NDIS Provider Type
What Makes Your Business a Good Fit
Why do you want to be listed in the directory?*
What value do you provide specifically to NDIS providers?*
What sets you apart from competitors?*
Exclusive Partner Opportunities

The directory is the first place we look for podcast guests, event speakers, workshop collaborators and Provider Collective partners.
Please indicate if you’re open to the following exclusive partner opportunities (optional):

Podcast interviewsWebinar presentationsEvent speaker panelsProvider Collective exclusive offersTechnology demosCase studies or co-branded contentNot at this time
Supporting Materials
Upload a 1:1 image. Fit your logo inside a square. Minimum 300x300px so it won't be pixelated and blurry.

Click here for a Canva logo size template.
Logo (PNG preferred)*

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Brand colours (optional)
Headshot for key contact (optional)

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Any promotional video or demo link (optional)
Agreement and Approval
Name (for agreement and approval)*

First NameLast Name
Date of submission*

MonthDayYear
Date

Payment Form

NDIS Directory Annual Listing

Incl GST

$880.00AUD

Enter coupon

Total

$0.00AUD

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Should be Empty: