Business Name	*	ABN	*	State	-- ACT NSW NT QLD SA TAS VIC WA *
BUSINESS AGENT OR REPRESENTATIVE
First Name	*	Surname	*
BUSINESS DETAILS
Phone	*	Mobile		Email	*
BUSINESS ADDRESS
Street:	*	Suburb	*	Postcode	*
Postcodes your business operates in (comma separated list)			*
How many homes does your business construct per year?			-- 1-5 more than 5 < 10 more than 10 < 25 over 25
How many extension projects does your business undertake per year?
LICENCE AND MEMBERSHIPS
Builders Licence No	*	Expire	*
HIA membership No		Expire
MBA membership No		Expire
BUSINESS LOGO
Your Logo			Business logo to be supplied as high quality JPG or PNG image, width 480 px,height 52 px, max file size 900 kB . NB. If you do not have a business logo available or Boral deems your logo unsuitable for display, the application will display your business name only (font determined by Boral).
Please enter your preferred login name and password to access customised version of the BoralSampler. Your password must be at least 6 characters long.
Login	*	Password	*	Confirm Password	*
I own/have proper authorisation from the owner to provide business 'content' being photos, logos, digital images or text for use with Boral Sampler *
I have read and agree with Boral Sampler Terms of Use. *