Ideal Prepaid 88880000   CONTRACTOR AGREEMENT#  Ideal Prepaid  Installer Application  Manual Form
Installer Services
CONTACT DETAILS
CONTACT NAME
Contact e-Mail
Cell Phone# Phone#
BUSINESS DETAILS
REGISTERED nAME OWNERSHIP TYPE
company ID number    
Trading names
Nature OF Business
Phone Fax
Street  Address City
province/State postal code/ZIP
AREAS SERVED
TRADE REFERENCES (Indicate for what type of installations licensed certification has been obtained)
QUALIFICATIONS
ACCOUNT DETAILS
payment preference
Direct Deposit Cheque  
Bank Name Account#
Routing# Account Type
AUTHORIZATION (Person authorized to sign Contractor's Agreement)

I/We authorize the company to Debit/Credit the above account with respect to any fees due in terms of this agreement. I/We understand and agree to all the terms and conditions prescribed by IdealPrepaid Pty (Ltd)  ('the company') as presented in the Terms and Conditions document which I/We have read.

Name     TITLE     Date

 
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