Resellers Online Application

Company Registered Name *

Trading as

Company Registration Number *

VAT Number

Tel *

Fax

Cell: *

Email *

Website

Physical Address *

Postal Address

Number of Staff *

Nature of Business *

Service Area *

Business Director/Owner *

First

Last

Accounts Department

First

Last

Buyer/Merchant

First

Last

Name of the person who completed this application *

Applicant confirmation *

Name