REGISTRATION APPLICATION FORM

Fill in the form below to apply to be added to the www.piercingnet.com listing at $35.00 per year. A consultant will contact you shortly after submission of this form to arrange payment details.

Business Name:
Address:
Suburb/City:
State:
Postcode:
Telephone:
Facsimile:
Email:
 

 

Are you registered with a local health authority?
 

 

Suggested Description of Services:
Ear Piercing: Nose Piercing: Body Piercing:

 

 

Twenty word description of your service:

 

 

 

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