New Company Customer Contact Form

Please fill in the form below to apply as a new company / customer with HLS Healthcare. Please note all fields are mandatory. For any further help or queries, please do not hesitate to contact us and we can help guide you through. This form may take a few minutes to complete.

Company Name

ABN

Company Phone

Company Email

Street Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Primary Contact

First

Last

Position

Department

Primary Contact Email

Confirm Email

Mobile

Site Name

Site Phone

Site Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Accounts Department Name

First

Last

Title

Accounts Phone

Accounts Email

Confirm Email

HLS Rep who has sent you this form:

Form Completed By

First

Last

Title Address Site

Completed By Email

Signature

Clear Signature

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HLS Healthcare is proud to be an Official Sponsor for

HLS HEALTHCARE PTY LTD
VIC HEAD OFFICE
Phone: 1300 931 893
67 Henderson Road
Rowville VIC 3178

NSW OFFICE
Phone: 1300 931 893
24/7 Anella Avenue
Castle Hill NSW 2154

HLS HEALTHCARE PTY LTD
Brisbane | QLD
Phone: 1300 931 893

HLS HEALTHCARE PTY LTD
Adelaide | SA
Phone: 1300 931 893

HLS HEALTHCARE PTY LTD
Perth | WA
Phone: 1300 931 893

HLS HEALTHCARE PTY LTD
Darwin | NT
Phone: 1300 931 893

HLS HEALTHCARE PTY LTD
Hobart | TAS
Phone: 1300 931 893

HLS Healthcare are the exclusive suppliers of Guldmann Hoists and provide mobility solutions for the Aged Care, Hospital, Community, Changing Places and personal care.
Our solutions and services are available Australia wide.
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New Company Customer Contact Form

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