Registration for Mouth Gargle

Registration

Please complete this form if you are keen to register your interest and book a timeslot to collect a bottle of Mouth Gargle.

The estimated time to complete this form is 5 minutes.

Your Details

Please enter the details of the person who will be collecting the mouth gargle at the collection location. Confirmation emails used for verification during collection will be sent to this email address, and other details may be used for support purposes. Be sure that your collection representative is informed before you complete the registration process.

Residential Address

Your residential address may be used to verify your registration for support purposes only.
If your residence does not have a floor or unit number, please enter NA instead.

Enter your SP Account Number

Your SP Account Number can be found on your SP bill for residential utilities, including water use.

My SP Account is for a:

I am collecting for: