HazardCo NZ: Website Sign Up Form with Credit Card

Let’s get you set up!

Fill in your details below to join HazardCo and start making health and safety simple on your sites. This form will take less than 5 mintues to complete and you'll need to have your business details handy.
Legal Company Name*
Trading Company Name (may be the same as above)*
Full Name*

First NameLast Name
Email Address*
example@example.com
Phone Number*
Please enter a valid phone number.
Billing Address*

Street Address

Street Address Line 2

CityState

Post CodeCountry

Confirmation and Payment
Please confirm what subscription you are looking for, provide your payment details and agree to the HazardCo Terms and Conditions.
Select your Subscription Type*
Billing Frequency - How often would you like to be invoiced, Annually or Monthly?
{HZC_DISC_TEXT}

Subscription invoicing amount and payment details*

NZD

Your payment information is securely processed by Stripe with PCI-compliant encryption—your payment details are never stored on our servers.
By completing this payment you agree to the following:
- I acknowledge the HazardCo membership has a 12 month contract term that auto renews annually
- I acknowledge and accept HazardCo's T&C's and Privacy Policy as made available on the HazardCo website. HazardCo Terms & Conditions and HazardCo Privacy Policy
- I approve HazardCo to charge my credit card
- I acknowledge I am aware of and accept the price of the HazardCo subscription
Should be Empty:

Let’s get you set up!