finance.gov.au

Contact and help

Home >> Procurement >> ICT Procurement >> Australian Government Telecommunications Arrangements (AGTA) >> Application form

Application for a Head Agreement Under the Australian Government Telecommunications Arrangement

The information provided in this application will be used to draft a Head Agreement for your organisation. A signed Head Agreement is required before the applicant can provide telecommunications services to Australian Government Departments and Agencies.

Note: Fields marked with * are mandatory

Organisation Details

* Organisation's Legal Name (e.g. XYZ Pty Ltd)
* Short Organisation Name (e.g. XYZ)
* Australian Company Number (ACN) or Australian Registered Body Number (ARBN)
* Australian Business Number (ABN)
* Physical Address
* Postal Address
* Telephone Number
Fax Number
Website address
* Contact details for issues regarding the Head Agreement (please include name, email address and phone number)
* Contact details of Financial Officer (please include name, email address and phone number)

* Insurance Details including:
- Public liability insurance policy number & coverage amount
- Product liability insurance policy number & coverage amount
- Professional indemnity insurance policy number & coverage amount
Service
Service Comments / further information

Contact for information on this page: ictprocurement@finance.gov.au

Back to top

Last Modified: 20 June, 2011