Know your Customer

Please fill out the form below and then we’ll be in touch shortly to attend to your request.

Company / Individual Details
Customer Type*
Driver's License
Max. file size: 16 MB.
Please upload a photo of your driver's license
Company / Individual Name*
Company Registration No. (Eg. ABN, NZBN, Overseas Registration No. or N/A if individual)*
Trading Name
Website Link - if Individual type NA*
Industry*
Industry - Other
Trading Address - Ensure the full trading address is entered*
Street Address City State / Province / Region ZIP / Postal Code
Registered Address- If different from Trading Address
Street Address City State / Province / Region ZIP / Postal Code
Country*
Company Telephone Number*
Email*
Accounts Payable Contact Name
Accounts Payable Email Address
Do you have Marine Cargo Insurance (Yes/No)*
Confirmation
All business undertaken is subject to the Company's Standard Trading Conditions, which may limit or exclude the Company's liability and contain indemnities benefiting the Company’s, copies of which are available <a href="https://www.coastalbridge.com.au/trading-terms-conditions/" target="_blank">here</a> and upon request.*
All business undertaken is subject to the Company's Standard Trading Conditions, which may limit or exclude the Company's liability and contain indemnities benefiting the Company’s, copies of which are available here and upon request.*
Privacy and Personal Information*
Privacy and Personal Information
The privacy of your personal information is important to Coastal Bridge, and we will ensure that it is held, used and disclosed consistently with the applicable privacy laws. Full details can be found in our Collection of Personal Information Policy which is available here. By submitting this form, I acknowledge that I have read and agree to the policy.*
I confirm the information provided in this form is true and correct.*
I confirm the information provided in this form is true and correct.*
Your Name*
First Last
Position*
Date*
MM slash DD slash YYYY
Phone
This field is for validation purposes and should be left unchanged.

Know your Customer

Know your Customer

Company / Individual Details

Confirmation

TRANSPORTING YOUR CARGO AROUND AUSTRALIA AND BEYOND

TRANSPORTING YOUR CARGO AROUND AUSTRALIA AND BEYOND