Application Form
LOGIN
HELP/SUPPORT
PRIVACY
ACCOUNT APPLICATION
New clients can apply for online accounts by completing and faxing the application form below provided or contacting us by phone.
After completing the following application form click "Print Display".
In accessing your on line services,
you agree:
1. Hazlett Information Services [Hazletts] will acquire as our agent all goods and services that we ask them to acquire for us; and
2. We will be primarily liable to the suppliers to Hazletts for the cost of those goods and services; and
3. We will otherwise pay Hazletts for those goods and services and Hazletts' own services on the terms and conditions advised to us by Hazletts from time to time and agreed to by both of us.
4. We have read, understand and agree to
Hazletts Privacy Statement
.
Account Details
:
Applicants First Name:
Applicants Last Name:
Company Details( if applicable)
:
Company Name
ACN:
ABN:
Clients Main Area of Business:
Address/Mailing Details
:
Street Address:
Suburb:
State
Please Select
Aust Capital Territory
New South Wales
Northern Territory
Queensland
South Australia
Tasmania
Victoria
Western Australia
Postcode
Postal Address:
Email address:
Telephone:
Fax:
Comments/Notes:
Signature:
__________________________________________
(
please note signature required before faxing
)
Level 704/60 Park Street, Sydney 2000
Ph: 02 92615211 Fax: 02 92647752.
R Hazlett & Co.
ABN
20 104 470 340
www.hazlett.com.au
Privacy Statement
