Security Of Payments Act Online Claim Form

First name:*

Last name:*

Your business name:*

Your business ABN:*

Your best contact number:*

Your email address:*

What state was the work done in?*

When did you last work on the job?

Please tell us what type of work you did and what led up to this payment dispute.

How much are you owed?*

Who owes you the money?*

What is their ABN? (write unknown if not known)*

What are their contact details? (phone numbers, fax, email, address etc)*

Attached documentation:

I have attached a copy of the contract or purchase order from my client (see upload section below)
I have attached a copy of my outstanding invoice / claim / payment claim? (see upload section below)

Please attach any copies of abovementioned documents here:

You may upload multiple files if required.

Drop files here or

How many years in two centuries? (To stop the spam bots - enter as a number not a word)*

Submit button will appear below when answer is correct.

Phone

This field is for validation purposes and should be left unchanged.