Business register

Register your business for the $100 million Public Housing Stimulus Program

To register your interest, complete the form below.

Required fields are marked with an asterisk (*).

Note: Please ensure you have completed the vendor maintenance form and upload with this registration form.

Details

Business or company name*
ABN or ACN
Contact person and position *
Business address*
Post code*
Postal address (if different from above)
Phone number*
Mobile number*
Fax number
Email
Website
Number of employees*
Business turnover (last financial year)*

Do you identify as an Aboriginal business?

Declaration

Number of trainees / apprentices:

Are you currently contracted under a panel arrangement by any NT Government department? *

Are you a Northern Territory Government employee? *

Business capability

Region you can service (Eg. Darwin, Kathrine, Tennant Creek, Alice Springs):

What type of work best suits your business activities?*

If other, please specify:

Trading licences

Electrical type / class / grade

Electrical licence number

A class:

C class:

Plumbing type / class / grade

Plumbing licence number

Plumbing / draining licence number :

Certified licence number:

Building type / class / grade

Building licence number

Restricted:

Unrestricted:

Air conditioning / mechanical type / class / grade

If other, please specify:

Air conditioning / mechanical licence number

ARCtic:

Other:

Asbestos removal type / class / grade

Asbestos removal licence number

Asbestos removal class A:

Asbestos removal class B:

Current insurance policy up to $10,000,000*

If yes, please provide insurance details below.

Name of insurer:

Insurance expiry date:

Public Liability Insurance

Vendor maintenance form

If you have any issues in relation to lodging the form, please contact the department on 8999 8896 or email housing.stimulus@nt.gov.au.

Last updated: 10 December 2018