Work With Us Form

Network Provider Input Details

* Indicates required field

GENERAL INFORMATION

Business Name *

ABN *

Address *

Postcode *

Suburb *

State *

BANKING INFORMATION

Bank Account Name *

Bank BSB *

Bank Account Number *

TERMS AND CONDITIONS *

I accept the terms and conditions

CONTACT INFORMATION

Main Contact *

First

Last

Main Phone *

Mobile *

Emergency Phone *

Email address *

Website *

Other Contact *

First

Last

Other Phone *

SERVICE LOCATIONS

Locations List *

List of Locations *

SERVICE INFORMATION

Type of Service *

Region Serviced *

Type of Vehicle *

Please enter the minimum and maximum towing weights, as well as whether you can service lowered vehicles?

Towing Details *

Please enter all you Insurance details (Insurance Coverages eg: Professional Indemnity, Hook Liability and Public Liability)

Comment *

Please upload your scanned documents below

Insurance document 1 *

Max file size: 20MB

Insurance document 2 *

Max file size: 20MB

Other files *

Max file size: 20MB

Please enter the fees you charge for each service.

Fee for 20kms *

Fee for 100kms *

Fee for 50kms *

Fee for 250kms *

Submit

Network Provider Input Details

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