Application Form - OH&S Web Directory


Application Form & Tax Invoice ABN 30 870 772 381
INSTRUCTIONS - Return by post the Application Form with your cheque, if you want a banner or to be hosted on our site please provide relevant information and graphics in electronic format, banners 470 pixels by 70 pixels.
SECTION 1 Provide organisation and contact details
Business Name :
Postal Address :

Telephone : ( )	Email :
Facsimile : ( )	Internet : http://www.
Authorising Person :	Signature :
Position :	Date :

SECTION 2 Select the product categories from our list for your link or banner.
[ ] Air & Gas Monitoring [ ] Book Suppliers [ ] Biological Safety [ ] Chains, Slings, etc. [ ] Chemical Safety Data [ ] Chemical Spill Control [ ] Chemical Storage [ ] Cleaning Equipment [ ] Clothing - Protective [ ] Computer Software [ ] Construction Safety [ ] Cranes & Hoists [ ] Electrical Safety [ ] Emergency Showers [ ] Ergonomic Equipment [ ] Ergonomic Furniture [ ] Eye & Face Protection [ ] Fall Protection [ ] Fire Safety [ ] First Aid [ ] Floor Mats - Fatigue [ ] Floor Mats - Non-slip [ ] Footwear [ ] Hand Protection & Gloves	[ ] Hearing Protection [ ] Laboratory Safety [ ] Lighting [ ] Lockout & Tags [ ] Machine Guarding [ ] Material Handling Aids [ ] Mining Safety Equipment [ ] Mirrors - Convex [ ] Noise & Vibration Control [ ] Online Databases [ ] Pressure Vessel Safety [ ] Rescue Equipment [ ] Respiratory Protection [ ] Safety Equipment [ ] Signs & Posters [ ] Test Equipment [ ] Tools & Equipment [ ] Tools - Ergonomic [ ] Traffic & Carpark Safety [ ] Vehicle & Plant Safety [ ] Ventilation & Extraction [ ] Videos - Health & Safety [ ] Water Safety Equipment [ ] Welding Safety
If there is no category in the above list that reflects your products we are happy to consider a new category for your link, the new category for our listing is: ……………………………………………..

SECTION 3 Costs are in Australian dollars, payment to AI & OHS Consultants for 12 months listing.
One link to your Internet site - select the category from above list - (yes / no)	FREE
Additional links are $50 per link - number of additional links required ________ - (yes / no)	$
Banner in a product category $500 per banner, select category - banner to be provided - (yes / no) (Banner to be be provided in electronic format, 470 pixels by 70 pixels)	$
Hosting one page of information with one link - $250 - text and graphics to be provided) - (yes / no)	$
Other as negotiated - (yes / no)	$
Total of above	$
10% GST on the above	$
TOTAL COST	$
Special requests: