The following customer has requested user id.

Personal Details:
-----------------
Agent/Broker Name:<%requiredname%> 
Type of Business(Agent,Broker,Wholesaler):<%requiredbusinesstype%>
Contact:          <%requiredcontact%> 
Position:         <%requiredposition%>
Street Address:   <%requireddelivery_street_address%>
Street Address 2: <%delivery_street_address2%>
Suburb:           <%delivery_address_suburb%>
City:             <%requireddelivery_address_city%>
Postcode:		  <%requiredpostcode%>
Dx Number:	  <%dx_number%>
PO Box Number:	  <%delivery_address_pobox_number%>	
Office Phone No.:        <%requiredphone_office%>
Mobile Phone No.:        <%requiredphone_mob%>
Fax:              <%fax%>
Office Generic Email Address:    <%requiredemail%>
Thank you