| Email Address: |
Email Format: |
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Your email address is your user name. |
| Re-Enter Email Address: |
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| Password: |
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Required |
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| Security Question: |
What is your favourite drink?
What was your mother's maiden name?
What was the name of the street you grew up on?
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Required |
Choose one. This question will be used to verify your identity should you forget your password. |
| Answer to Security Question: |
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Required |
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| Participant Name: (e.g. East Side Winery, Gin Brothers etc.) |
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Required |
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| Name and Surname of Contact Person: |
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Required |
Please enter only one person's name. |
| Contact Number for Contact Person: |
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| Website address: |
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| Facebook address: |
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| Instagram address: |
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| Hashtags most often used on social media: |
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Details exactly how it will appear on the Tax Invoice |
| Company name as it will appear on the Tax Invoice: |
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| Street Address: |
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| Suburb: |
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| City: |
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| Postal Code: |
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| Province: |
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| VAT#: (NA if not applicable) |
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| Country: |
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Details of the person, and address where stickers should be couriered:
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| Company that will receive the stickers: |
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| Name and Surname of Contact Person: |
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Required |
Please enter only one Person's name. |
| Contact Number for Contact Person: |
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| Email address of Contact Person: |
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| Street Address: |
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| Suburb: |
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| City: |
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| Postal Code: |
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| Province: |
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| Country: |
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| Special Instructions: |
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| Name of person in charge of payments: |
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| Phone number of person in charge of payments: |
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| Email address of person in charge of payments: |
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Company Logo upload (optional)
Please upload your company logo with dimensions 1080 x 1080 pixels (optional).
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