Customer Application Form

By completing a order through this site, and selecting 'remember my details' your details will automatically be recorded, and your order underway, however if you feel that the online process is not for you, please complete the below application. Note: We will get back to you within 1-2 business days with confirmation on your account status.

Property Owner Details

First Name

Last Name

Property Name

Property Address

Property Suburb

Property State

Property Postcode

PIC Number

Account Holder Details

First Name

Last Name

E-mail

Work Phone

Home Phone

Mobile Phone

Delivery Address

Delivery Suburb

Delivery State

Delivery Postcode

I am interested in livestock ID solutions for
Cattle
Sheep
Deer
Goat

I understand that the terms of this account with Avoca ID is that payment is due within 14 days of purchase.
Yes