Transcript
ANZ Merchant Services Additional Terminal Request
Corporate and Institutional Customers only. Please use this form if you wish to order an additional terminal for an existing outlet. *Designates Mandatory Field.
Office Use Only WIN:
MERCHANT Details Merchant Number*
Existing Terminal ID*
(This number can be found on your merchant statement)
Chain Number
1 7 0 0 1 8 0 0
Store No. (max. 4 digits):
Group Number
Company Name
Trading Name*
Trading Address Street Address* (Where terminal will be located)
Suburb/Town*
State* Postcode*
Postal Address (If different from above)
Suburb/Town*
State* Postcode*
Attention of:
Contact Name Title
First Name*
Last Name*
Contact Phone Number* (
Mobile Phone Number*
)
Email*
You acknowledge that ANZ may use this email address to keep you informed of the progress of this request.
TERMINAL AND DELIVERY INFORMATION Number of
Type of Terminal*:
Additional Terminals*:
A NZ POS Turbo A NZ POS Mobile A NZ POS Plus A NZ POS Plus Contactless A NZ POS Turbo Plus A NZ POS Turbo 2 ANZ POS Mobile 2 ANZ POS Plus 2 ANZ POS Mobile Plus
Cable Requirements* USB
Serial
Line Type*: Please indicate the primary and second forms of communication (eg: IP, Dial-Up or GPRS) as per available for the terminal.
Other. Please Specify:
Preferred Installation Date (dd/mm/yyyy) Installation Contact Name*
Contact Phone Number*
(
)
Mobile Phone Number*
Delivery Address Street Address*
Suburb/Town*
State*
Postcode*
Special Instructions (Maximum 300 characters)
Australia and New Zealand Banking Group Limited (ANZ) ABN 11 005 357 522.
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ANZ Merchant Services Additional Terminal Request
MERCHANT’S AUTHORITY Important Information Australia and New Zealand Banking Group Limited ABN 11 005 357 522 (ANZ) is collecting the personal information of the contact listed above in order to action the request set out in this form. By ticking this box, I/we declare that the individual/individuals concerned is/are aware or I/we will immediately make them aware of the following: 1. ANZ’s contact details; 2. ANZ is collecting their personal information from me/us in order to action the request set out in this form. Without this information, ANZ may be unable to action this request; 3. ANZ may disclose their personal information to: any agent, contractor or service provider ANZ engages to carry out or assist its functions or activities; any related entity of ANZ; participants in the card scheme; and other financial institutions;.
4. ANZ may disclose their personal information to recipients located overseas. Information about where overseas recipients may be located can be found in ANZ’s Privacy Policy and at www.anz.com/privacy; 5. ANZ may use their personal information or disclose their personal information to its related entities or organisations that are in a product or marketing alliance with ANZ (alliance partners) to help ANZ, its related entities or alliance partners to promote or provide a product or service. If they do not want ANZ to tell them about its products and services or those of its related entities or alliance partners, they may call 13 13 14 at any time to withdraw their consent; and 6. ANZ’s Privacy Policy (found at www.anz.com/privacy) also contains information about how the individual/individuals concerned may access or seek correction to their information, and raise concerns that ANZ has breached the Privacy Act or an applicable code and how ANZ will deal with those matters.
How to Lodge Please note: All check boxes must be checked and mandatory fields completed before ANZ can process this request. Submit via email
Mail to: ANZ Merchant Services Locked Bag 10 Collins Street West Post Office Melbourne, VIC, 8007 Fax to: 1300 78 66 99
Australia and New Zealand Banking Group Limited (ANZ) ABN 11 005 357 522. Australian Credit Licence Number 234527. ANZ’s colour blue is a trade mark of ANZ. Item No. 84080 05.2014 W389100
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