Capricorn Account Application

Account Information

ABN*
Business Name*
Business Type
Business Status
Trading Name (if different to your Business name above)
Capricorn Number*
Location*
Suburb State
Details of staff members you would like a user login generated for*
Name Email Phone Copy of Invoice Emailed(Y/N) Access to Invoices via iCONSIGNIT (Y/N)

Add up to 10 users
Your Name :*
First Last
Your Email :*
How did you hear about KIS?*
- Web Search
- Capricorn Media
- Capricorn Staff Member
- Capricorn Supplier
- Referral from Capricorn Member
- Referral from a non Capricorn Member
- KIS Staff Member
Referring Capricorn Member Number or Business Name*
Referring Capricorn Supplier Number or Business Name*
Referring Business Name*
Terms & Conditions*
I have read and I accept KIS Group of Companies Terms & Conditions, and accept the $5 plus gst Account Service Fee charged per invoice.
CAPTCHA
Name
This field is for validation purposes and should be left unchanged.

Name	Email	Phone	Copy of Invoice Emailed(Y/N)	Access to Invoices via iCONSIGNIT (Y/N)