Cellarit Registration

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Account Information * Indicates Mandatory Fields

Title:*

Given Name:*

Family Name:*

Company Name (optional for invoice):

ABN#, VAT#, etc. (optional for invoice)

Choose a Password (min 5 characters):*

Confirm Your Password:*

Email Address:*

Confirm your Email Address:*

Delivery Details (Residential or Business Address. No PO Boxes Please!)

Location Label (this is not part of the address):

Own Label:

Address Line 1 (or Company Name)*

Address Line 2

Suburb / City:*

Country:*

Postcode / Zip:*

State:*

Daytime Telephone (include area code):*

Mobile Telephone:

Instructions if nobody is available to sign, e.g. "Leave at front door"*

Optional - Payment Details (encrypted)

For Wine Storage customers who wish to enroll in monthly Autopay (payment options)

Card Type:

Note: Amex payments (only) incur a 4% surcharge

Card Number:	Expiry Date:	CVV#: Last 3 digits printed on signature panel or 4 digits printed above acct# for Amex
	/

Age Declaration*

All Cellarit customers must be of legal age (18 years in Australia) or older.

	Day	Month	Year
Date of Birth:

How did you hear about Cellarit?

Other (please specify)

Terms & Conditions

I agree to the Cellarit Terms & Conditions