Business Details
Registered Name:
Please amend to preferred trading name if appropriate *
Entity Type *
Industry Sector:
Industry Sub-Sector:
Trading Address Details
Address Search: *
Address not in list
QBCC Details
QBCC License Number:  
*Please Note:
If there is more than one director for your Business. Please ensure that 2 Directors details are entered on the Application.
Your Billzy Referrer
Applicant Referrer
First Name:
Referrer's Member Number
Director Details
Title: *
First Name: *
Middle Name:
Surname: *
Date of Birth: * (dd/mm/yyyy)
Gender: *
Current Address
Address Search *
Address not in list
Time at Address: Years  Months *
Contact Details
Phone Number:
Email Address: *

Add Director
Your Banking Details

Please insert details of the bank account to which your merchant facility will be attached.
Banking Details

Account NameFinancial Institution and BranchAccount BSBAccount Number

The above account will be the account to which all payments received through your merchant facility will be made. It is also the account from which all Billzy fees (as set out in the Billzy Member Agreement) will be debited. The Account must be in the same name as the Billzy member. Please check the details before moving to the next screen. Incorrect details may result in delays in finalising your Billzy Membership and / or the establishment of your merchant facility.

Although you may be accepted as a Billzy Member, Billzy is required to verify the details of this account before your merchant facility can be activated.