ApplicationForm

Application To Provide Services

This is an application made by the named Community Patrol's authorised person (the purchaser) to purchase services offered by OnTheWeb Limited (the provider) as indicated below.

* Indicates required field

Full name of your Patrol *

Your Patrol callsign *

Authorised persons name *

First

Last

Position held *

Email to use regarding this application *

I am authorised to make this application *

Yes - Currently approved Yes - Requires additional approval

Your Patrol's physical address *

Your Patrol's mailing address *

Please select the services below that you require *

> Electronic Reporting System and maintenance package for one year $600 (No hardware) > Special 3 month $100 Trial Offer (No hardware) > Total Package $749 (Includes hardware) > Total Package $999 (Includes hardware) > ERS Challenge Participant

Phone Number 1 *

Phone Number 2 *

Once you have placed this order, we will get in touch to confirm what you require to be included in your services.

Submit

Community Patrols of New Zealand Charitable Trust (CPNZ) is not associated with this offer or service.