PERSONAL DETAILS

First Name *

Last Name *

Email Address *

Telephone Number *

COMPANY DETAILS

Company Name

ABN

DELIVERY ADDRESS (NO PO BOXES)

Street Address *

Suburb *

State *

Postcode *

BILLING ADDRESS

Same as the delivery address *

Street Address/PO Box *

Suburb *

State *

Postcode *

IF YOU ARE A 30 DAY ACCOUNT OR VIP CARDHOLDER PLEASE ENTER YOUR ACCOUNT INFORMATION BELOW.

Account Name / VIP Card Number

Please upload proof of your trade qualification / proof of apprenticeship

Please note that it may take up to one week for your account to be created after you submit this form. An email confirmation with login details will be sent to you.

Any questions? Contact us here.

Boom. Done. You’ve just applied for an account with Salon Hair Care!

Hang tight, your account has been submitted for approval.

We’ll be in touch soon!

Boom. Done. You’ve just applied for an account with Salon Hair Care!

Hang tight, your account has been submitted for approval.

We’ll be in touch soon!

PLEASE NOTE SALON HAIR CARE IS TRADE ONLY.

PUBLIC NOT SUPPLIED.

Boom. Done. You’ve just applied for an account with Salon Hair Care!

Boom. Done. You’ve just applied for an account with Salon Hair Care!

NIOXIN SYSTEM 5 SCALP AND HAIR TREATMENT 100ML