Greenbank Environmental

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Greenbank customer application form

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Your Details

Trading Name

ABN

Street Address

Suburb

Postcode

Phone Number/s (business hours)

Email For Remittances

Primary Email

Installer Details

Installer Full Name

Installer Mobile Number

Installer Email

Installer Address

Electrician Licence Number (PVD, Hot Water & Heating and Cooling claims requiring an Electrician on site) Optional

Installer’s SAA/CEC Accreditation Number (PVD Claims) Optional

Plumbing Licence Number (STC, ESC & VEEC Hot Water Claims) Optional

ARC Licence Number (Heating & Cooling Claims) Optional

Additional Installer Details

Additional Installer Full Name Optional

Additional Installer Email Optional

Additional Installer Address Optional

Additional Installer Mobile Optional

Electrician Licence Number (PVD, Hot Water & Heating and Cooling claims requiring an Electrician on site) Optional

Installer’s SAA/CEC Accreditation Number (PVD Claims) Optional

Plumbing Licence Number (STC, ESC & VEEC Hot Water Claims) Optional

ARC Licence Number (Heating & Cooling Claims) Optional

Claim

Will You Be Claiming Optional STC PVD (National)STC Hot Water (National)VEEC Hot Water (VIC)VEEC Heating & Cooling (VIC)ESC (NSW)PRC Batteries (NSW)

Required Documents

Public liability certificate

(4MB max size)

Contractors License Photo ID

(4MB max size)

ASIC Certificate of Registration of a Company

(4MB max size)

Banking Details

Account Name

BSB

Must be six digits

Account Number

Must be less than 10 digits

How did you find us / sales person

Please choose an option

Name of Referral Optional

Please Specify Optional

Schedule my training demo with a sales representative Optional

I confirm that I have read and agree to the terms and conditions outlined in the Installer / Supplier agreement

Got a question?

Call us now

1300 473 362

Register with Australia’s most respected trader and creator of environmental certificates.

Greenbank customer application form

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