Client Lounge

Client Registration Application Form

Enter as much detail as possible which will help us to help you get your work done with MindWars® easier.

Login Details

* = Required fields
Username *    
    Please enter your preferred user name.
Must be a 2-30 character word with no spaces and a
combination of letters and/or numbers (no punctuation).
Password *    
    Please enter your preferred password.
Must be a 5-30 character word with no spaces and a
combination of letters and/or numbers (no punctuation).
Time Zone    
    Times will be displayed using our office time zone by default.
You can select an alternate time zone for your local time.
This can be modified at a later date.

Your Details

* = Required fields
First name *    
Last name *    
Work Email *    
    If you have done work with us in the past and we have communicated
by email. Enter your email, first name & last name then click the Lookup button.
Your company information will be retrieved from our database.
Salutation    
Preferred Name    
NOTE:     Preferred Name is how you like to be referred to.
Enter any shortened names or nick-names here.
Sex     Male Female
Birthday     Day   Month   Year 

Phone Numbers

Work *     Area *   Number *   Ext 
Mobile/Cell    
Home     Area   Number 

Other Emails

Home    

Work

Position    
Department    

Instant Messaging

MSN    
AOL    
ICQ    
Yahoo    
Jabber    

Company Details

Company    
ABN    
Phone     Area   Number 
Fax     Area   Number 
URL/Home Page    

Address

Street    
City/Suburb    
State    
Postcode/Zip    
Country    

Home Address

Street    
City/Suburb    
State    
Postcode/Zip    
Country