Customer Registration Form

--- What Customer Registration Means - click here ---

Business / Entity Details
Type Structure of the entity
Name The company / business name
ID Type eg ABN
ID Number eg ABN or RBN
Mailing Address For postal correspondence
Physical Address If different to above	As Above
Phone
Fax
Email Address
Additional comments
Details of Contacts
Primary Contact	Secondary Contact
Name	Name
Position	Position
Phone	Phone
Fax	Fax
Mobile	Mobile
Email	Email
Responsible for...	Responsible for...
General Issues	General Issues
Invoices	Invoices
Web Site Coordinator	Web Site Coordinator
Any Other Information Relating to these Contacts:
Acknowledgement of Client Agreement
I hereby acknowledge that I have read, understood and agree to the terms and conditions outlined in the current client agreement published at http://www.intouchweb.com.au/agreement.htm (click to load agreement in new window) and will be bound by that agreement if I decide to commence any service provided by inTouch web services Pty Ltd Your Name * Required field *
Referral Details (if relevant)
inTouch web services was recommended to me by the following person or company (Leave blank if not applicable)
Service Requested
Please indicate the service you are interested in. If the service is not listed (or you are unsure) please select Other/Not Listed
Other Instructions or Comments
If you wish to order a service immediately or you have any other comments to add, please do it here Security Question To help us avoid spammers, please copy the following word into the field below it - all lower case

Please submit your registration now by
clicking on the button once

WHAT CUSTOMER REGISTRATION MEANS

Registering as a new customer does NOT commit you to use our services.

The information simply allows us to add your details to our database as a potential customer, thus allowing you to begin using our services at any time in the future, and for us to be able to invoice you correctly if you decide to do so.

No information provided by you will be used for any other purpose than the above.

To register we ask you to agree to our current client agreement in the event that you subsequently commence any of our services. You may wish to read this agreement first. Click here if you wish to view the current agreement in a new window.

Most fields are optional but we would appreciate as much detail as possible please.

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