Become a Dealer

*Company Name
Registration Number

VAT number

*Company Telephone number

*Company Email address

*Company Address

*Street Number & Name	*Suburb
*City	*Code

*Trading Hours:

Mondays - Fridays:

From

- to

Saturdays:

From

- to

Sundays:

From

- to

Public Holidays:

From

- to

*How many registered Directors/Members

Please supply up to 4 Member/Director information & documents (if more than 4 members the extra information & documents will be required to be sent via e-mail)

*Applying Director/Member #1 Full Name & Surname	*Director/Member #1 ID
*#1 Email	*#1 Cell number

Director/Member #2 Full Name & Surname (if applicable)	Director/Member #2 ID (if applicable)
#2 Email (if applicable)	#2 Cell number (if applicable)

Director/Member #3 Full Name & Surname (if applicable)	Director/Member #3 ID (if applicable)
#3 Email (if applicable)	#3 Cell number (if applicable)

Director/Member #4 Full Name & Surname (if applicable)	Director/Member #4 ID (if applicable)
#4 Email (if applicable)	#4 Cell number (if applicable)

*Person responsible for Accounts & Payments Full Name & Surname

*Accounts Email address

*Accounts Cell number

*Copy of Director/Member #1 ID Document

Copy of Director/Member #2 ID Document

Copy of Director/Member #3 ID Document

Copy of Director/Member #4 ID Document

*Physical Address Confirmation Member/Director #1

Physical Address Confirmation Member/Director #2

Physical Address Confirmation Member/Director #3

Physical Address Confirmation Member/Director #4

Company Registration Documents

Extra Company Registration Documents

VAT Registration Document

I hereby confirm that I have read and agreed to the Dealership terms and conditions

I hereby confirm that I have read and agreed to the Credit Report Authorization Conditions

Optional Notes

OUTDO BATTERIES

COMPANY

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