WESNET Rides Signup Form

Email address of person completing form*

A copy of what you submit on this form will be emailed back to you for your records.

Enter Email Confirm Email

Your Agency Details

Your Agency Name*

State/Territory*

WESNET Membership Number*

Please enter your WESNET Membership number (with no W-). If you don't know your number please call us on 1800 937638 or email us at [email protected]

Please enter a number from 0 to 9999.

Details for your User Log in Set up

The Email you will use to log in to WESNET's Central Account*

Generic/team email address for setting up the Uber Account. For example [email protected] or [email protected] If there is more than one staff member ordering rides you will need access to an email you can share.

Enter Email Confirm Email

Do you have a mobile number that can be used for your agency?*

Yes
No

Agency Mobile Phone Number*

Enter a mobile phone number that will be used for 2-step authentication when you log into your agency Uber account. Again it may be best to use an after hours mobile number or a mobile that is shared amongst team members if you are planning for more than one staff member to book rides. It's best if the number is not already connected to an existing Uber Account.

Will you be able to get a mobile phone number to use?*

Access to the Uber Central account requires 2-step authentication via SMS. So a mobile phone number is required to access the program. You may wish to consider whether you require more than one staff member to access the Uber dashboard, before you nominate an individual staff member's mobile number.

Yes
No

Authorised Person

Authorised person*

Please provide the name of the manager or authorised person who delegated to sign Agreements/Contracts on behalf of your agency. (This is usually the CEO unless your agency is very large).

First Last

Authorised Person's Email*

WESNET will email the Agreement for signing to the authorised person.

Enter Email Confirm Email

Authorised Person's Phone*

Please provide a contact number for the Authorised Person. This is a national program, please include your area code if you are giving us a landline.

Day-to-Day Contact

Day-to-day contact*

Who is the best person for WESNET to contact for day-to-day issues?

Same as person completing this form
Same as Reponsible person listed above
Someone else

Day to Day Contact Email*

Enter Email Confirm Email

Day-to-Day Contact Phone*

NB - this is a national program, so don't forget to give us your Area Code if you are using a landline.

Phone

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

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