"*" indicates required fields We are collecting your personal information in accordance with the Information Privacy Act 2009 for the purpose of processing this application/request. The information will be only accessed by authorised employees. Your information will not be given to any other person or agency unless you have given us permission, or we are required by law.Your detailsName/Company/Business* Postal address* Street Address Address Line 2 Town or city State Post code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Australian business number (ABN)* I have an ABN. I do not have an ABN. ABN* Are you registered for GST?* Yes No Are you* supplying good? supplying services? supplying goods and services? receiving a grant or funding? Upload a completed Statement by Supplier (ATO Form — NAT3346-05.2012)*Max. file size: 100 MB.Do you have a shop front or business location in the TRC Region?* Yes No Shop front address* Street Address Address Line 2 Town Account Contact InformationContact name* First Last Email* Phone*Sales/Orders Contact InformationAre the contact details for sales/orders the same as accounts?* Yes No Contact name* First Last Email* Phone*TRC contactDetails of TRC officer who sent you this form.Name* First Last Email PhonePayment detailsDo you want to be paid via BPay or direct deposit?* BPay Direct deposit BPay biller code* BPay customer reference number* Bank name* Account name* BSB* Account number* ConditionsTablelands Regional Council (TRC) is under no obligation to verify the accuracy of the bank details provided. Future changes in bank/company details are to be provided in writing to TRC. TRC will take no responsibility for any delays in payment or errors due to factors outside reasonable pay controls, including but not limited to, delays or errors in the banking system or errors in the account details. I understand that, if I do not provide my ABN TRC will be obliged to withhold 46.5% of the payment and remit it to the Australian Taxation Office. TRC reserves the right to terminate or suspend this direct credit payment and to make payment by other means they may determine from time to time. The supplier agrees to return to TRC any payments credited to the supplier in error, and TRC reserves the right to off-set the amount of any overpayment made in error against any existing or future debit or liability owned by TRC. Subject to the contract, the principal shall pay the amount due to the supplier including applicable GST before the end of the payment period. If an amount is due from the supplier to the principal, the supplier must pay that amount including applicable GST with 25 business days of receiving written notification to this effect from the principal. TRC’s standard Terms and Conditions apply to all purchases. Acknowledgement* I have read and agree to the above conditions. The details I have provided in this form are true and correct This authority is provided in accordance with our current bank authorities and/current company policies.
