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Business details
Business name: *
Contact name: *

Physical address
Street *
Suburb
City *

Postal address (if different to above)
Street
Suburb
City

Contact information
Business Phone:
Free Phone:
Cell Phone:
Fax:
Contact email: *
Web site:
G.S.T. number:
Bank A/C Name:
Bank A/C No.:
Bank Statement Reference
if not completed, default wording will be 'Nelson Tasman Tourism'
Comments:

Account information
Username:
You don't have to provide a username in which case we will create one based on your business name.
Password: *
Repeat Password: *
The password must be at least 6 characters long.

Misc.
Local advertiser: *
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Terms and Conditions
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Notes

A local business is defined as one whose operation is based in and/or conducts substantial local business activity in the Nelson Tasman region