iBack - Application Form

Application Form

Complete the form below for access to the iBack system. Please note, you will be sent an Email with your login details at which point you will be ready to use iBack.

Please Note: This form uses Java scripts and will utilise your default email program to send the information to LUCID Technologies. If you do not have Java enabled on your browser (and do not wish to) and/or you currently do not use a local email program, you can fill out the form with the required information and fax it to LUCID Technologies on 03 9723 9378.

* Denotes required information

Postal address same as street address

Company/Business Name
ABN/ACN
* Contact Name
* Phone Number
Fax Number
Mobile Number
* Street Address
* Suburb
* State
* Post Code
Postal Address
Suburb
State
Post Code
* Email Address
* Select *iBack* Plan
Preferred Username Must be between 8 & 16 characters and can be made up of letters (upper or lower case) and numbers.

Additional Comments

Please read the Terms and Conditions before you submit this form.

I have read and agree to the terms and conditions.

All information entered in this form is for LUCID Technologies' internal use, no information is passed onto any other organisations unless warranted by law. For more information regarding this, refer to our Privacy Policy.