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Personal Details
Address Details
Account Details

First Name:

Last Name:

Email:

Phone:

Mobile:

User Name:

Password:

Company ABN:

Company/Business Name:

From Date:

To Date:

Company Website:

Postal Address Type :

Unit Type:

Unit Number:

Street Number:

Street Name:

Postal Delivery Type:

Postal Delivery Number:

Street Type:

Town/Suburb:

State:

Post Code:

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BSB:

Account Number:

Account Name:

Greenbot Account Manager:

Client Number:

ASO Accreditation Number:

Licensed Electrician Number:

CEC Designer Number:

SE Role:

Design Install Design & Install

Compliance Identification Checks:

Directors drivers license:

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Accreditation Documentations: (CEC,electricial,contractor license)

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Proof of business address: (Utility bill or bank statement with address detail visible)

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Public liability insurance:

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Signature:

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