New Device Form

Selling Dealer Details
Registered Company Name (If Pty. Ltd or Ltd):*
Trading Name:*
ABN:
Street Address:*
Address (cont.):
Suburb:*
State:*
Post Code:*
Work Phone:*
FAX:
Company Website Address:

Purchase Order Details
Name of Person Placing This Order:*
Position Held:*
Email Address:*
Phone:*
FAX:
Mobile Telephone Number:
Purchase Order Number :

Accounts Payable Details
Accounts Payable Contact Name:*
Email Address:*
Phone:*
FAX:
Selling Dealer Details
Billing Street Address:
Suburb:*
State:*
Post Code:*
Plantcom Sales Person:

Purchaser Details
Registered Company Name (If Pty. Ltd or Ltd):*
Trading Name:*
ABN:
Street Address:*
Address (cont.):
Suburb:*
State:*
Post Code:*
Work Phone:*
FAX:
Company Website Address:

Purchaser Login Details
Preferred Username:*
Preferred Password:*

Machine Make
Machine Model
Voltage
State
Rego
Machine Name
Machine Type

Trackers

Type Of GPS Tracking Required:
Number of GPS Devices Required:
Any special comments you wish to add:
Terms and Conditions of Sale:- Please read carefully and acknowledge:
The Purchaser agrees with the terms and conditions of sale please answer YES (type in capital letters) :*

Reminder - Prior to Submitting this form please download banking Direct Debit Forms,
Complete them  and email to sales@Plantcom.com.au