Billing Information

Agent Information

Agent Information *

Yes, I am an Agent acting on behalf of the client
No, I am the Client

Please note: If you are filling out this form as the Agent for the Client, or as the Client, you will be responsible for any delays in commencement of the project, should the information in this form be incorrect.

Agent Name *

First

Last

Agent Phone *

Agent Email *

Client Information

Full Client Business Name *

Please use the full legal name of the business.

Agent Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

I am an Individual or Entity without a Company Registry Number

Company Registry Number *

Visit to find your Company Number at the New Zealand Companies Register.

Billing Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Same Address

Billing Address is the same as Physical Address

Company Physical Address (If different from Billing Address)

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Accounts Payable Contact *

Accounts Payable Email *

Accounts Payable Phone No *

Job Details

Engineer Present On The Job

Yes

Leave blank if there was no Engineer on the job.

Engineer Name *

Engineer Email *

Engineer Phone *

Would the Engineer like a copy of the Report?

Yes

Contact On-Site *

Contact Job Title *

Contact Phone *

Site Location *

Please include Apartment/Unit/Building/Warehouse Number if applicable.

Is this a Secured Facility? *

Yes
No

Facility Access Instructions

Please provide detailed instructions for access.

Final Step

CSI Job Number *

This will be located at the bottom of your Quote/Charge up Letter

Purchase Order Number *

Purchase Order Number IS ESSENTIAL if your company uses them, otherwise enter the Job Address as reference.

Where did you hear about us?

Quote/Charge Up Letter *

Click or drag a file to this area to upload.

Please upload a signed PDF of your Job Quote or Charge Up Letter.

terms *

I agree that all information has been entered correctly, and that any errors in data entry may cause the job to be delayed or cancelled.

terms *

Yes, I agree to the Terms & Conditions

Streamline the Billing process

Agent Information

Client Information

Job Details

Final Step