Registration Form – Licensing

Select your state

Full Name *

Business Name *

Business ACN *

Email Address *

Mobile Number *

QLD Client ID

QLD Client Possession License

QLD Client User License

TAS Client License Number

TAS Client RAIN Number

Laser Room Name

Do you already have a POSSESSION license?NoYes

Do you already have a USER license?NoYes

BUSINESS DETAILS

Street Address (BUSINESS) *

City (BUSINESS) *

State (BUSINESS) *

Post Code (BUSINESS) *

Storage Place Name

Street Address (STORAGE) *

City (STORAGE) *

State (STORAGE) *

Post Code (STORAGE) *

Street Address (POSTAL) *

City (POSTAL) *

State (POSTAL) *

Post Code (POSTAL) *

Street Address (RESIDENTIAL) *

City (RESIDENTIAL) *

State (RESIDENTIAL) *

Post Code (RESIDENTIAL) *

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