Please fill out the form below to register your interest and we will try our best to get you piccolo-ing in no time! ABOUT YOU. First Name Last Name Your Email Phone Number Your City State – Please select an option –New South WalesVictoriaQueenslandWestern AustraliaSouth AustraliaTasmaniaAustralian Capital TerritoryNorthern Territory Current Occupation Have you visted any of our stores? – Please select an option –YesNo How did you hear about us? – Please select an option –Family or FriendsGoogle SearchFacebook/Instagram/TwitterNewspaper/Magazine ArticleFlyers/Brochures sent to my homePostersIn-stores (please name) Other (Please specify) YOUR NEW POTENTIAL PICCOLO ME STORE. Which site are you interested in? – Please select an option –New SiteNORTH ROCKS (6/213 North Rocks Rd, North Rocks NSW 2151)KINGS PARK (40/15 Valediction Road, Kings Park NSW 2148)LIDCOMBE (Foyer of the Forensic Medicine & Coroners Court Complex, 1A Main Ave, Lidcombe NSW 2141)WERRINGTON (Werrington Park Corporate Centre, Western Sydney University, Great Western Highway, Penrith NSW 2750)MOOREBANK (400 Moorebank Ave, Moorebank NSW 2500)WOLLONGONG (Innovation Campus, North Wollongong NSW 2500)LONSDALE MELBOURNE (456 Lonsdale St, Melbourne VIC 3000)SPENCER MELBOURNE (120 Spencer St, Melbourne CBD VIC 3000) Other (Please specify) Do you have a budget in mind? – Please select an option –up to $250,000$250,000 - $450,000$450,000+ Do you need finance? YesNo When will you be ready to operate? – Please select an option –Now3-6 months6-9 months12 Months Why choose Piccolo Me? Lastly, how would you like to be contacted? PhoneEmailI don't mind either
