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Loyalty Member
Corporate Account Application Form
Please complete the information below to apply for a Corporate Account. The details will be appointed to a dedicated Account manager, who will be in contact with your shortly and provide you with further tools to, check rates, make bookings and track account details.
COMPANY INFORMATION
Company Name:
Trading Name:
Company Address:
Suburb/City:
State:
--State--
ACT
NSW
NT
QLD
SA
TAS
VIC
WA
Post Code:
Postal Address (if different):
Suburb/City:
State:
--State--
ACT
NSW
NT
QLD
SA
TAS
VIC
WA
Post Code:
Website:
ABN:
CONTACT INFORMATION
Title:
--Title--
Mr
Mrs
Ms
Miss
Dr
First Name:
Surname:
Business Telephone:
--
02
03
07
08
Mobile:
Facsimile:
--
02
03
07
08
Email Address:
Job Title:
OTHER INFORMATION
Number of travelling employees:
0-10
11-20
21-50
50+
Average cars needed per month:
1-3
4-6
5-9
10+
Number of company owned vehicles:
1-5
6-10
11-20
20+
Type of Vehicles Used:
Small Hatchbacks:
YES
NO
Large Sedans:
YES
NO
SUV's / Wagons:
YES
NO
Minivan's:
YES
NO
Ute's:
YES
NO
Trucks:
YES
NO
Preferred method of monthly payment:
--Select--
Credit Card
Electronic Payment
Direct Debit
Cheque
Cash
Other
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