Bremick Online Customer - Authorisation Form

To add or amend the details of an authorised online user, please complete the following form.

Customer Details

Customer name

Customer code

Authorised user’s business address

City

State

Postcode

Country

Accounts payable email address

Authorising New User(s)

Upon receipt of this form, Bremick will send an email to the authorised user(s) with login access details.

* Mobile number is required for sending password updates and pin numbers to the authorised user when required.

CONFIRMATION OF DETAILS AND AUTHORISATIONS (TO BE COMPLETED BY EITHER MANAGING DIRECTOR, GENERAL MANAGER OR CFO)

I authorise the user(s) whose details appear above to perform online orders, and I/we authorise you to accept and act on any instructions given by that user.

Privacy Statement

The personal information we collect on this form will be used by us to register you with products/services you are applying for. It may be disclosed to other members of Bremick staff, service providers who do things on our behalf (e.g. mailing house) or to other third parties where it is required or allowed by law or where you have otherwise consented.

You can access the information we have collected, if we have retained it, by calling Customer Service on 02 8332 1055. If you do not complete all the fields we will be unable to complete the registration.