Fred IT Referral Form

Smart Health referral form

Complete this form if you're a FRED IT user interested in CommBank Smart Health for Pharmacies – our payment solution that offers flexible ways to pay, whether in store or remotely.

Note: You can also complete the form on behalf of someone else.

* Required

Are you a CommBank customer?

Yes

First name

Last name

Business name

Postcode

Contact number

Tell us a little more about your business.

3000 characters remaining

How would you like to be contacted?

Call

When should we get in touch?

Thanks for helping us with this information. Once you’re happy with your answers, read the below before you submit.

By submitting the information above, you and any third party whose information is being provided confirm your answers to be true and correct and consent to us using this information to communicate electronically, by phone or SMS, including to provide updates, reminders and (unless you tell us not to) information about our products or services. Where you are submitting the above information on behalf of a third party, you confirm that you have captured the consent of that party to share their information with us. You and any third party whose information is being provided agree that we may use and disclose the personal information collected in this form to assess your application as set out in your Privacy Consent. For information on how we collect and handle personal information including how you can access and collect your personal information please see our Group Privacy Statement. Fred IT Group are not part of, nor act on behalf of, the CBA Group and does not distribute the products and services CBA provides. If you purchase a CommBank Smart Health facility, CBA may pay a commission to Fred IT Group.