• 1. Account Details
  • 2. Work Details
  • 3. Address Details
  • 4. Account Beneficiaries
  • 5. Review Information
  • 6. Form Submitted
Account Details
KEY ACCOUNT INFORMATION
Type of Account *
The account type default is automatically selected.
IF you find the default to be incorrect, please correct it. For additional services information, please click here.
ELSE, leave it as is.
Designated Facilitator *
Identify the Facilitator primarily responsible for managing this service account.
Select the designated facilitator from the drop-down list. When unsure, please select the option 'Other...' and - once the form is submitted - you will be contacted to finalize the account's designated facilitator.
For more AltanaESP-facilitator information, please click here.
Account Name *
The account name is used to correctly identify the account in the AltanaESP admin system.
For companies and organizations, please enter the company or organization's name here.
For individuals and families, enter the initials and surname of the responsible account holder.
Account Password *
The password entered here, along with the account primary email address (serving as username) will be the login credentials to edit account information and details.
Please select a password of at least 8 characters, containing 1 lower (e.g. x) and 1 uppercase letter (e.g. X), a number (e.g. 7) and 1 special character (e.g. #,%, $ or *).
TAKE NOTE!
Passwords are not saved with submitted records. PLEASE, keep your own password record.
ACCOUNT HOLDER INFORMATION
Title
Name *
Name of the person responsible for paying invoices and settling outstanding account balances.
Surname *
Surname of the person responsible for paying invoices and settling outstanding account balances.
Initials
Please only enter a maximum of 4 initials, all in upper case.
ID-number *
Please, only enter the ID-number - of the person responsible for the account - without any additional formatting.
The entered ID-number also - together with the primary email address (serving as username) - act as the password to provide online access to the service account's financial records.
CONTACT DETAILS
Mobile * () -
Use the Tab-key to enter the 10 digit number as follows: First 3 digits in the first box, the next 3 digits in the second box and the last 4 digits - of the 10 digit code - in the third box.
Landline () -
Use the Tab-key to enter the 10 digit number as follows: First 3 digits in the first box, the next 3 digits in the second box and the last 4 digits - of the 10 digit code - in the third box.
Fax () -
Use the Tab-key to enter the 10 digit number as follows: First 3 digits in the first box, the next 3 digits in the second box and the last 4 digits - of the 10 digit code - in the third box.
Primary Email *
The primary email address serve as the main email address for this service account
All invoices, correspondence, communications and/or documentations will be send to this email address.
In addition, it also serve as the username - together with the registered account ID-number (password) - to provide online access to the account for checking balances and records of outstanding invoices or payments made. AND, together with the account's registered password, provide online access to add, edit or change account information.
Secondary Email