Applicant Form Company Name * Trading as Trade Name A.B.N * A.C.N Type of Business * default Private Company Public Company Sole Trader Partnership Trust Premises Address * Address Line 1, Including Unit Number Telephone Fax Address Line 2 How long established * How long at present address * Suburb * Premises Status * default Owned Outright Mortgaged Rent / Leased Parents Property Paid up Capital default A$ 0~25,000 A$ 25,000~75,000 A$ 75,000~150,000 A$ 150,000 + State * default ACT NSW NT QLD SA TAS VIC WA Post Code * Business Size * default 1~5 Employees 6~20 Employees 21~100 Emplyees 100 + Employees Annual Electrical Spend default A$ 0~25,000 A$ 25,000~75,000 A$ 75,000~150,000 A$ 150,000 + Postal Address if different Applicant Name * Position Mobile * Address * Property Status * default Owned Outright Mortgaged Rent / Leased Parents Property Phone Fax Email * Business References 1 * Contact * Phone * Email * Business References 2 * Business Name Contact * Phone * Email * Business References 3 * Business Name Contact * Phone * Email * Other Message reCAPTCHA Submit
