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Shopper Registration
Please complete the form below to register with Langford Kelly to become a shopper. Please note that at the end of your registration you will be required to supply photo identification.
Your Details
First Name Last Name
Gender Male Female Date of Birth dd/mm/yyyy
Phone Mobile
Email
Confirm Email
Bank Details
Bank or Institution Name Account Name
Account BSB Account Number
Home Address
Address
Suburb Postcode
State    
Mailing Address Same Address as Home Address above
Address
Suburb Postcode
State    
How did you hear about us?
Please include where you heard about us as we’d like to know what’s working for us and we want to be able to thank people for their referral.
Search Engine:    
Friend/Family:    
Flyer/Advertisement:    
Other:    
Facebook      
Twitter      
The following information is used for our clients who may need shoppers who fit a targeted profile. If you want to be considered for these special assignments, simply fill out all the remaining sections. All information on this application, including demographic information, is kept strictly confidential and is used for assignment purposes only. Your information will not be shared with any other company and is used only by authorised Langford Kelly personnel.
Your Profile
Marital Status Single Engaged Married Separated Defacto  
Residential Status Rent Living with Parents Boarding Own Home  
Hair Colour Blonde Brunette Black Auburn White/Grey  
Eye Colour Blue Brown Green Grey Hazel Violet  
Wear Glasses Yes No  
Clothing Size XS S M L XL XXL 3XL+  
Digital Camera Yes No  
Education High School TAFE Trade Diploma University  
Languages Spoken English Chinese Italian Vietnamese Greek     Other:
3 Favourite Shops
 
 
Please provide us with an example of a recent positive or negative shopping experience. You will be graded on your writing sample.
ABN  
  If you don’t have an ABN (Australian Business Number) you MUST click here to download this form and complete it stating that you are doing this work as a hobby. This is all you need if your earnings from Langford Kelly mystery shopping jobs are less than $5000 per year. Please email, fax or post this form back to Langford Kelly to complete your application as soon as possible.

I confirm that the above information is accurate to the best of my knowledge
and I have read & agree to the Shopper Terms & Conditions
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