Section 1 Company Name
Registered Address
ACN No:
ABN No:
Section 2 Trading Name:		Ph No:
Trading Address:		Fax No:
Post Code:		Email Address:
Section 3 Business Structure:	Public Company Private Company Trust Partnership Sole Trader
Business Type:	Retailer Wholesaler
Length of time in Business:
Proprietors Name:
Proprietors Contact Number:
Section 4 How did you hear about us:	Apparel Magazine Rag Trader Trade Fair Direct Mail Agency Others
Nature of Enquiry:	Pricelist Order procedure Stock availability Others