Retailer Online Registration Form
Please enter the information in the boxes below.

Fields marked with * are mandatory.
Owner / Store Profile
Visible store name *
Eg. Pagewood Convenience Store (as seen on Shop front)
Legal trading name *
Eg. Pagewood Multi Businesses Pty. Ltd
Owner's name *
Eg. Mr. John William Smith or IT Company "Nominees Pty. Ltd"
Phone no. * -
Eg. 02 - 99999999 		Mobile no.
Eg. 0401999999
Fax no. -
Eg. 02 - 99999999 		Email *
Eg. name@domain.com
Tick this box if the Key Contact is SAME to the Owner's Details stated above.
Key Contacts in Store
Contact name *
Eg. Mrs. Mary Anne Doe
Person's role *
Store phone no. * -
Eg. 02 - 99999999 		Mobile no.
Eg. 0401999999
Store fax no.; -
Eg. 02 - 99999999 		Store email *
Eg. name@domain.com
Physical Store Address
Shop no.  
Eg. Shop 13A
Street no./name *  
Eg. 100 Pacific Hwy
Centre name  
(if applicable)  
Eg. Pagewood Shopping Centre
Suburb *  
State *                           Postcode *  
Tick this box if the Billing Address is SAME to the address stated above.
Billing Details
Biller Name *  
Eg. Mr. John William Smith or IT Company "Nominees Pty. Ltd"
Street no./name *  
Eg. 100 Pacific Hwy
Suburb *  
State *                           Postcode *  
Miscellaneous Information
A.C.N.     
Eg. 123000999
A.B.N. *     
Eg. 99123000999
Registered for GST *   Yes   No
Bank Details (Optional)
Please provide details if you wish to receive your incentive payments electronically. Otherwise the incentive payments will be issued via cheque.
Bank name  
Address  
Account name  
BSB  
(Bank, State, Branch number)
Eg. 999999
Account no.  
How did you find out about us? 
For other ways, please specify: 
Email Subscription
Quatro can keep you imformed of specials and the latest Supplier information via our Branded Emails and Newsletter. Select your level of email subscription from the drop-down list below.
Supplier Account Details (Optional)
Depending on which state you are in, different suppliers are connnected to Quatro.

This information is optional, however the information you provide will assist us in connecting suppliers that you currently trade with.

Please click here if you would like to fill in your Supplier Account information.

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Disclosure of Personal Information
As a Quatro customer, you have the opportunity to receive magazines, newsletters or free samples of products from third parties that are associated with Quatro. Please note that in order for you to receive these benefits, we will pass on the personal information that we hold about you to these third parties. If you would like further information about how we use your personal information, please refer to the Privacy Statement on the Quatro site. If you do not wish to have your personal information disclosed to third parties please contact Quatro on 1800 QUATRO (1800 782 876).