Altech Computers

DEALER APPLICATION FORM

Dealer information

Registered business name*

Trading as

Business address*

Suburb / city*

State*

Post code*

Phone*

Fax

E-mail*

Mobile

Postal address(if not as above)

Post code

ABN*

ACN

Type of business*

Date of incorporation*

State*

Bank*

Branch*

Phone*

Names, date of birth and residential address of directors/partners

Name*

DOB*

Address*

Name

DOB

Address

Name

DOB

Address

Trade references

New Entity

Business name*	Contact name*	Phone*	Fax
Business name	Contact name	Phone	Fax
Business name	Contact name	Phone	Fax

Anticipated possible monthly purchases $

Office

Office*

Disclosure

I/We the undersigned declare that the above application is true and correct and agree to the Terms and Conditions as outlined in the current dealer price list. I/We accept the Trading Terms its being STRICTLY COD unless otherwise agreed with an Authorized Officer of Altech Computers. I/We are personally guarantee to pay in full for any goods which have been received by the above mentioned and are held personally liable for any outstanding debts at any stage.

Signature

Name:		Position:
Signature:		Date:

Witnessed:		On This Day:
Name:		Position:

PLEASE NOTE this application can only be signed personally by the Proprietor, by at least two partners or by the Director and the Secretary of the Company.

PLEASE INCLUDE BUSINESS REGISTRATION CERTIFICATE

Download PDF Version

When you have completed the form press the "Print This Form" button to view and print your Dealer Application from a new window. Once printed, please sign the form and FAX it to the appropriate Altech Office (Sydney, Melbourne, Brisbane or Perth).

The fax numbers are:

Sydney:	(02) 8831 9988
Brisbane:	(07) 3017 2020
Melbourne:	(03) 9558 5091
Perth:	(08) 9242 7383