ACC111 Register as an ACC vendor

Complete this form if you are a new vendor providing goods or services to ACC clients and want to register your organisation or sole practitioner as an ACC vendor.

What you need to fill out this form

Before you start, please ensure you have the following:

  • your business information including IRD number
  • your business contact details, including referrals/purchasing and payments/remittance contact details as applicable
  • a screenshot of your business bank account details that you’d like payments made into (showing your bank account name, number and bank logo clearly visible)
  • an estimate of the number of invoices that you will submit to ACC each month.

Once you have all the relevant information, please allow around five minutes to enter it, as the form can’t be saved.

Need help?

Contact our provider helpline if you need help completing this form.

Phone 0800 222 070

When we collect, use and store information, we comply with the Privacy Act 1993 and the Health Information Privacy Code 1994. For more information read our privacy policy.

Our privacy framework

Business information

Are you a registered company?
Are you GST registered?

Address information

Please do not provide a private or confidential address as it may be visible on client records.

Organisation contact details

Is the referrals (purchasing) contact different from the main organisational contact?
Is the payments (remittance) contact different from the main organisational contact?

Working with us online

If you plan to submit more than 10 invoices a month or need to submit ACC45 injury claim forms, you need a digital certificate so you can work with us online.

We’ll send you this form to fill out once we have registered you.

How many invoices will you submit a month?

Payment information

Attach a copy or screenshot of the bank account details for the account you want us to make payment into. Please ensure that your bank account name, number and bank logo are clearly visible in the uploaded attachment.

Your attachment needs to be smaller than 1MB.
Do you have authorised signatories who can approve change requests on behalf of your organisation?

Authorised signatory information

Declaration