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Company / Individual Details

Customer Type*

Driver's License

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Company / Individual Name*

Company Registration Number*

Enter ABN if registered in Australia, or leave blank

Enter NZBN if registered in New Zealand, or leave blank

Enter ARBN if foreign company registered in Australia, or leave blank

Enter NZ registration number if the foreign entity is registered in NZ, or leave blank

Enter overseas registration number

Enter N/A if the entity is an individual

Trading Name

Website Link - if Individual type NA*

Industry*

Industry - Other

Trading Address - Ensure the full trading address is entered*

Street Address City State / Province / Region ZIP / Postal Code

Registered Address- If different from Trading Address

Street Address City State / Province / Region ZIP / Postal Code

Country*

Company Telephone Number*

Email*

Accounts Payable Contact Name

Accounts Payable Email Address

Do you have Marine Cargo Insurance (Yes/No)*

Confirmation

Standard Trading Conditions: All business subject to Coastal Bridge's Standard Trading Conditions. View our terms here.

Privacy: The privacy of your personal information is important to Coastal Bridge. We collect, hold, use and disclose personal information in accordance with the Privacy Act 1988 (Cth) and Privacy Act 2020 (NZ). Read out Privacy Policy here.

Authorized Signatory Declaration

Full Name of Authorized Signatory*

Position / Title*

Date*

Customer Onboarding Form

Company / Individual Details

Confirmation

Authorized Signatory Declaration

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