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Lease Details
*
Indicates required field
Date lease to commence
*
Lease to be paid
*
Monthly
Quarterly
Annually
Agreed monthly lease amount (plus GST)
*
I'm leasing this licence as
*
an individual
a company/partnership/trust/incorporated association
Your Details
Email
*
Name
*
First
Last
Phone
*
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Upload File: front of drivers licence
*
Max file size: 20MB
Upload File: back of drivers licence
*
Max file size: 20MB
Business Details
Organisation name (if applicable)
*
Organisation street address (if applicable)
*
ABN or ACN
*
Your role within organisation (if applicable)
*
Customer Reference Number (CRN)
*
Vehicle Details
Vehicle make, model and body shape
*
Month/Year manufactured
*
Passenger seating capacity (Front and back; excluding driver)
*
Is this vehicle wheelchair accessible?
*
No
Yes
Have you, or a related entity, within the previous 12 months, had a booked hire service licence, limousine licence or taxi service licence cancelled or suspended?
*
No
Yes
Have you, or a related entity, within the previous 12 months, committed an offence against relevant transport legislation relating to providing a booked hire service or taxi service, or using a motor vehicle to provide a booked hire service or taxi service?
*
No
Yes
Submit
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