New Network Partner Application

Step 1 of 5 – Company Details

Company Name(Required)

Company ABN(Required)

Company Registered Address(Required)

Street Address Address Line 2 Suburb State Postcode

Main Contact Person

This person will be the primary contact liaising with WiTWA representatives with regards to the implementation of DEI initiatives within your organisation.

Contact Name(Required)

First Last

Contact Email(Required)

Contact Phone Number(Required)

Authorised Signatory

This can be one of the contacts listed above OR a different contact but should be a person within your organisation with the authority to enter into a contract with WiTWA.

Is the primary contact also the authorised signatory?

Yes, this is the same person as the primary contact listed above

No, this is a different person from the primary contact listed above

Authorising Signatory Name(Required)

First Last

Authorising Signatory Email(Required)

Authorising Signatory Phone Number(Required)

Main Contact Person

Authorised Signatory

Reference One

Reference Two