Reseller Application

ABN (required)

Your Business

ACN

Business Name (required)

Trading Name (if different)

Number of Employees (required)

Address Line 1

Billing Address

Address Line 2

Suburb (required)

State (required)

Postcode (required)

As Billing Address

Delivery Address

Company Name (required)

Address Line 1 (required)

Address Line 2

Suburb (required)

State (required)

Postcode (required)

Extra information (eg. Up dirt road)

Name (required)

Primary Contact

Department (required)

Position

Phone (required)

Mobile

Fax

Email (required)

Website

Extra information (eg. Unavailable between 1pm and 2pm)

As Primary Contact

Accounts Contact

Name

Phone

Fax

Email

As Primary Contact

Marketing Details

Email (required)

Retail Products

Gaming Graphics Cards

Memory Modules

LCD/LED Monitors

Cases/Cooling Fans

Software

Pocket Disks/USB Drives

Notebooks/Netbooks

Hard Disk/Solid State/Portable HDD

CD/DVD/Blu-ray Optical Media

Power Supplies/CPU Cooling Fans

Soundcards/Speakers/MP3 Players

TV Tuners/Set Top Boxes/Media Players

Consumer Networking Products

DVD/Blu-ray Optical Drives

All-in-one PC

Keyboard & Mice

Laser & Inkjet Printers

Digital Still/Video & Photo Frames

All of the above

What products from Multimedia Technology are you most interested in?

Solutions

Toughbooks

Printers (Mobile)

UPS & Power Protection

Telecommunications

Business Networking Products

Servers

Data Storage (Tape & NAS)

All of the above

Commercial Display Solutions

Workstation Graphics

Commercial TV

Projectors & Screens

Commercial Display & Signage

Video Editing

All of the above

What best describes the nature of your business?

Corporate Reseller

Telstra Reseller

Wholesale

Other

Educational Reseller

Audio/Visual

Consultant

Government Reseller

Network/VOIP

Specialist

Extra Information

Who are your current suppliers?

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I hereby state the information provided above is correct and true, and that I agree to the terms & conditions for becoming a reseller of Multimedia Technology. (required)