Retailer Online Registration Form

Please enter the information in the boxes below.    Fields marked with * are mandatory.

Store Details Store name * Eg. Pagewood Convenience Store (as seen on Shop front) Address 1 * Eg. Shop 13A Address 2 Eg. 100 Pacific Hwy Suburb *   State *   Please select ACT New South Wales Queensland Northern Territory Victoria South Australia Western Australia Tasmania Postcode * Phone no. * - Eg. 02 - 99999999 Fax no. - Eg. 02 - 99999999 Point of Sale system used   None Electronic Cash Register Tower POS Solutions Access Surefire Microsoft POS Retech MYOB Retail Manager Breeze Radiant On Q Computer Link Free Choice Other Contact Details First name * Eg. Mary Anne Doe Last name * Eg. Henriques Mobile no. Eg. 0401999999 Email .* Eg. name@domain.com Email not available Preferred method of contact Order Reminder * All available Email Web SMS Order Exceptions * All available Email Web SMS Preferred method of training * Please select Quatro Field Staff (subject to geographic availability) Supplier Field Staff Quatro Telephone Support Self Other sites Tick this box if you have other sites that you would like linked to this one as part of a group. clicking Yes will activate a phone call from our customer care team. How did you find out about us?  Please select Internet / Web Trade Representative Quatro Representative Word of Mouth Magazine Other ways For other ways, please specify:  Email Subscription Quatro can keep you informed 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. All Emails No Emails Newsletters Only Branded Emails Only 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 1300 QUATRO.