PenTest NZ Order Form

Contact Name *

Practice Legal Name *

Contact number *

Trading name (if different)

Email Address *

PHO (if known)

Billing Address *

More information about the PenTest NZ services and their benefits is available here.

Which services are you interested in? *

Cyberscient.com (self‑assessment of cyber risks)External network penetration testing Dark web risk assessment

Optional Add ons

Cloud risk assessmentPhishing simulationFirewall security configuration assessmentInternal Network Pentest

Order totalexcluding GST

Please download the attached authorisation form, read, sign, and then upload the signed copy.

This form authorises PenTest NZ to perform security research on behalf of the Client and must be completed prior to engagement.

Upload signed authorisation form here *

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Please download the attached testing scope form, complete all required fields and then upload a copy.

This form helps PenTest NZ define the scope of testing for your practice.

Upload completed testing scope form here *

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How would you prefer we contact you about your order? *

PhoneEmail

Comments or Questions?

Your details provided on this form will be shared with PenTest NZ to process your order and provide the requested services.

For more information, see our Privacy Policy.

I understand that the information provided on this form will be shared with PenTest NZ to confirm my order and provide the requested services *

We’ll contact you within 5 business days to confirm your order and next steps.

By submitting this form, I confirm that I am placing an order for the items listed above.
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Privacy notice

Health Accelerator collects the information in this form to process your PenTest NZ order, communicate with you, and coordinate delivery of the selected services. We will share your details with PenTest NZ (our service provider) for this purpose.

We store your information securely and only keep it for as long as needed for the purposes above (and to meet legal/accounting requirements). You can ask to access or correct your information at any time by contacting us at contact@healthaccelerator.co.nz

For more detail, see our full Privacy Policy.