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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
Postcode

Postal Address:

Email address:

Telephone:

Fax:
Comments/Notes:





Signature: __________________________________________
(please note signature required before faxing )
Hazlett Information Services
Level 704/60 Park Street, Sydney 2000 | DX 1078 SYDNEY | GPO Box 96, Sydney 2001
Ph: 02 92615211 Fax: 02 92647752.
R Hazlett & Co.
 ABN 20 104 470 340
www.hazlett.com.au
Privacy Statement