WHC Service Provider Registration Form Business Name* Contact Name* Email* Phone*Address* Street Address Address Line 2 City State Postcode Please provide a brief outline of the services/programs you provideWhich category is most relevant to the services you provide* Housing and specialist homelessness services Education and employment services Legal and Financial services Health and wellbeing (dental, mental health, etc) Personal care (haircuts, food, clothing, etc) Tick all that applyPlease provide a copy of your public liability insurance certificate of currencyAccepted file types: jpg, png, eps, pdf, Max. file size: 2 MB.NB minimum $10 million requiredNameThis field is for validation purposes and should be left unchanged.
