Customer Information Form | Mackay Equipment Hire Company

Customer Information Sheet

Subject *

Business Trading Name:

Individual Name: *

ABN/ ACN:

Street Address:

Postal Address:

Phone Number

Mobile Number

Email for Accounts *

How long has the business been established: Years / Months

Date Established:

Primary Person - Name

Position / Title

Address

Date of Birth:

Home Phone:

Mobile Number:

Drivers Licence No:

Issuing State: *

Expiry Date:

Garaging Address:

Insurance / Damage Waiver

Yes

No - Self Insurance Certificate of Currency for Hire Equipment required

Excess applies for all damages irrespective of Damage Waiver option selected.

Upload Copy of Drivers Licence:

Submit