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External User Registration Form
  Required Field*  
  Title:*  
  First Name:*  
  Middle Name:  
  Last Name:*  
 
How do you want to receive your Password?(not required for Customer Online - Coal)
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Mobile Number:* Your password will be sent to this number
 
  Work Email Address:*  
  Secret Question:* Secret Question examples - Mother's maiden name, Name of family pet. Do not use company specific questions.  
  Secret Question Answer:*  
  Job Title:*  
  Company:*  
  Mine/Port Access Required: Do you require access to a mine or port? If so which ones?  
  What application are you requesting access to?*
Select an Application
 
  Do you require additional application access?*
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  Additional Applications:
 
Aurizon Contact Person:*
Aurizon Contract No (Ac. XXXX):*
Aurizon Contract Title:*
 
 
SharePoint Site:
 
Customer Account Number:
Manager's Name:
Manager's Position:
Manager's Phone:
Manager's Email:
 
 
Roles:
 
 
Practice:
 
  Comments/Reason for Access: (for Sharepoint access, please enter site description and the name of your Aurizon Contact)*  
 
 
 
Have you read and accepted
Aurizon IT's Terms and Conditions
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Click here to specify hyperlink
 
       
 

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