Work Authorisation Form

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Posted on 05 April 2022

To submit a Work Authorisation for Pothole People (ABN 94 109 481 834), either complete our online form (below) or download our Work Authorisation form.

Before submitting our online form, you will need to sign the form digitally and provide details of the work to be undertaken and job quotation. The online form cannot be saved and returned to at a later point. If you are an individual completing this form, please select ‘Individual’ under ‘Type of Business’ and add your name as the ‘Legal Name’.

"*" indicates required fields

Type of Business*

Sole Trader

Partnership

Proprietary Company

Individual

Other

Legal Name*

Other

Trading Name

ABN

Mobile*

Telephone

Project Address*

Street Address Address Line 2 City State Postcode

Office Address*

(physical address only, no PO Boxes)

Street Address Address Line 2 City State Postcode

Postal Address

Same as Office Address

Street Address Address Line 2 City State Postcode

Requested Start Date

Email*

Purchase Order Number (if required)

Proposal Number*

Is an Induction longer than 10 minutes required?*

Yes

If yes please note, 7 days notice ahead of work start is required. Contact the office with required documentation ph. 1800 768 465 or email info@pothole.com.au.

Extra Information (e.g. induction needs, gate number, access details etc)

Amount of job (ex GST)*

Estimator Name

I certify that the above information is true and correct and that I am authorised to make this application for credit. In accordance with the privacy act (1988), I authorise any person or company to give information as may be required in response to credit inquires. I have read and understood the General Quote Conditions of Ley Lines Pty Ltd T/A Pothole People Queensland which form part of and are intended to be read in conjunction with this Work Authorisation Form and agree to abide by these conditions.

Client Full Name*

Date*

Title*

Signature*

This quote applies to work carried out in business hours. Work conducted outside of business hours will incur a surcharge unless otherwise agreed. This quote is subject to our terms of trade available on our website: pothole.com.au

Phone

This field is for validation purposes and should be left unchanged.

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