Registration

Mrs

First Name*	Last Name*
Company
Postal address*
Suburb*	State*
Post Code*	Country*
Email*		Username Password * Password * Confirm Password *
Phone*	Fax
Comment*

Minimum*

Maximum*

What is your invesment capability*		Cash
		Property
		Equity
		Other Funds

Have you owned a business before?	Yes	No
Have you experience in Concrete Delivery?	Yes	No
Please enter some details of your past business experience*

The Company’s Head Office is located at 1/27 Kingtel Place, Geebung QLD 4034.

Telephone 1300 880 955 or Fax 07 3216 5823

The personal information on this enquiry is to allow Concrete Taxi to assess your application to purchase a Franchise operation. This form is not a contract and Concrete Taxi is not required to invite you to proceed with the purchase of a franchise. The form indicates your willingness to express serious interest in a franchise.

The information will be treated in the strictest confidence and will not be disclosed in full or in part to anyone other than Concrete Taxi management, advisers and the Franchisor you nominate.

If you are successful with your application and proceed to purchase the franchise business it will form part of your franchise file. If you are unsuccessful, the information collected will be destroyed 1 year after collection or at your specific request.