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Enviro Shop

(NB: A * beside a question indicates it is a required field. You will not be able to proceed until all these questions are filled.)

(1):	Business Trading Name *

(2):	Business Legal Name

(3):	Parent Company

(4):	NZRA Membership Number

(5):	Street Address

(6):	Postal Address

(7):	Region (based on Regional Council Region)

(8):	Store Type – based on ANZSIC classification

(9):	Website address