Client Form

First Name Enter your firstname here Last Name Enter your surname here

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Company Name (if applicable) Trade As Name (if applicable) Company Reg. No.(if applicable) Company Vat No.(if applicable)

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By submitting this form, you assure that all information given is accurate to the best of your knowledge, and that you consent to Adiogyn Pty Ltd T/A neXt I.T. Solutions retaining your personal information and that you agree to receive from time to time communications, in the form of emails, sms’s or phone calls for the purposes of notifications, and/or marketing.