Lodging Party

Box Number

DAS Customer Number

DAS
Form 013

 Form 014

APPLICATION FOR A DIAL-A-SEARCH 
ACCOUNT

I hereby apply for a dial-a-search account.  I agree to abide by the terms and conditions attached to this application and signed by me, and I undertake to advise the Registrar-General’s Office of any changes to the information below.

1. APPLICANT’S NAME IN FULL
     		

2. CUSTOMER ACCOUNT NAME (ie. Individual’s name/business name/corporation name/govt organisation name)
     		

3. E-MAIL OR FAX NUMBER – this number will be used for ALL search transactions and the provision of monthly accounts.
     		

4. CONTACT PERSON FOR ENQUIRIES
     		

5. TELEPHONE CONTACT FOR ENQUIRIES
     		

6. POSTAL ADDRESS
     		

7. APPLICANT’S SIGNATURE
     		

8. OFFICE USE ONLY
Approved/Not Approved	 	Approved By (signature)		
Date		Approved By (signature)		
Entered onto Tarquin		Entered By (signature)		
Entered onto Promadis		Entered By (signature)		
Entered onto Winfax		Entered By (signature)		
Entered onto Outlook List		Entered By (signature)		

The Registrar-General reserves the right to approve this application.  No contract will be entered into until the application is formally accepted by this office.