Sole Trader

SOLE TRADER

Section A - Ownership

Registered Name

Registered Address

Principal Place of Business

Trading Name

Section B- Address (Contact Details)

Postal Address

Business Address

Cell Number

Email Address

Section C- License

Type of License

License Number

Expiry Date

Name of Licensee/Nominee

Address of the Licensed Premises

Would You like to be an online Customer?

Yes

If no, Why?

I agree to the terms & Conditions

I confirm that the above information is true and correct

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