newcustomer – Battery Works Australia

New Customer Form

This form collects the necessary information for a new customer to be added to the Battery Works system.

Full Company Name(Required)

ABN(Required)

Registered Business Address(Required)

Street Address City State Post Code Country

Main business of the company(Required)

Primary Contact(Required)

First Last

Primary Phone(Required)

Primary Email(Required)

This email address will be used for order updates, product information and notifications.

Accounts

Accounts Contact(Required)

First Last

Accounts Email(Required)

Statements will be emailed to this address.

Credit Application(Required)

Yes

Required Monthly Credit(Required)

Names of Principals / Directors of the business

Supplier Credit Reference 1

Name

First Last

Phone

Supplier Credit Reference 2

Name

First Last

Phone

Supplier Credit Reference 3

Name

First Last

Phone

Delivery Information

Primary Delivery Address(Required)

Same as Registered Business Address

Street Address City State Post Code Country

Forklift available for unloading(Required)

Address Type(Required)

Signature

CAPTCHA

This field is for validation purposes and should be left unchanged.

New Customer Form

This form collects the necessary information for a new customer to be added to the Battery Works system.

Full Company Name(Required)

ABN(Required)

Registered Business Address(Required)

Street Address City State Post Code Country

Main business of the company(Required)

Primary Contact(Required)

First Last

Primary Phone(Required)

Primary Email(Required)

This email address will be used for order updates, product information and notifications.

Accounts

Accounts Contact(Required)

First Last

Accounts Email(Required)

Statements will be emailed to this address.

Credit Application(Required)

Yes

Required Monthly Credit(Required)

Names of Principals / Directors of the business

Supplier Credit Reference 1

Name

First Last

Phone

Supplier Credit Reference 2

Name

First Last

Phone

Supplier Credit Reference 3

Name

First Last

Phone

Delivery Information

Primary Delivery Address(Required)

Same as Registered Business Address

Street Address City State Post Code Country

Forklift available for unloading(Required)

Address Type(Required)

Signature

CAPTCHA

This field is for validation purposes and should be left unchanged.

New Customer Form

Accounts

Delivery Information

New Customer Form

Accounts

Delivery Information

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