Reseller Enrolment Kit DISTRIBUTOR APPLICATION/ENROLMENT FORM 1. Basic Information ORGANISATION (PERSONAL NAME FOR INDIVIDUALS): (required) LOCATIONS ADDRESS (required) TELEPHONES NOS: (required) YOUR EMAIL (required) 2. BUSINESS INFORMATION NATURE OF BUSINESS (required) REGISTRATION STATUS (PLEASE TICK AS APPROPRIATE) (required) SOLE PROPIETORSHIPREGISTERED BUSINESS NAMELIMITED LIABILITYPUBLIC LIMITED COMPANY (PLC) 3. DISTRIBUTION CATEGORY OF INTEREST DISTRIBUTION CATEGORY OF INTEREST (PLEASE TICK AS APPROPRIATE) (required) Reseller – Minimum order of 10 unitsDealer – Minimum order of 50 unitsSuper Dealer - Minimum order of 100 unitsState Super Dealer -Minimum Order of 250 Units 4. PRODUCT/SERVICE OF INTEREST PRODUCT/SERVICE OF INTEREST (PLEASE ENTER AS APPROPRIATE) (required) Product One (required) Product Two Product Three Product Four Product Five Product Six Product Seven Product Eight Product Nine Product Ten 5. KEY STAFF DATA NAME (required) TEL NO (required) DESIGNATION (required) EMAIL ADDRESS (required) NAME TEL NO DESIGNATION EMAIL ADDRESS
