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Reseller Application

This form is to open a New Account with Multimedia Technology Pty Ltd & does not provide Credit Terms.
The Multimedia Technology policy is to only deal with AV/IT resellers who are either a registered business or company.

Your Business

*ABN# - - -
ACN#
*Business Name
Trading Name(if different)
*Number of Employees

* Required Fields

Billing Address

*Address Line 1
Address Line 2
*Suburb
*State
*Postcode

Delivery Address

As above
*Company Name
*Address Line 1
Address Line 2
*Suburb
*State
*Postcode
Extra information (eg. Up dirt road)

Primary Contact

*Name
Department Description
*Phone
Mobile
Fax
*Email
Website
Extra information (eg. Unavailable between 1pm and 2pm)

Accounts Contact

As above
Name
Phone
Fax
Email

Marketing Details

As above
*Email

What products from Multimedia Technology are you most interested in?

Retail Products

Gaming Graphics Cards	Notebooks/Netbooks	Consumer Networking Products
Memory Modules	Hard Disk/Solid State/Portable HDD	DVD/Blu-ray Optical Drives
LCD/LED Monitors	CD/DVD/Blu-ray Optical Media	All-in-one PC
Cases/Cooling Fans	Power Supplies/CPU Cooling Fans	Keyboard & Mice
Software	Soundcards/Speakers/MP3 Players	Laser & Inkjet Printers
Pocket Disks/USB Drives	TV Tuners/Set Top Boxes/Media Players	Digital Still/Video & Photo Frames
All of the above

Solutions

Toughbooks	Telecommunications	Servers	Printers (Mobile)
Business Networking Products	Data Storage (Tape & NAS)	UPS & Power Protection
All of the above

Commercial Display Solutions

Workstation Graphics	Projectors & Screens	Video Editing	Commercial TV	Commercial Display & Signage
All of the above

Extra Information

What best describes the nature of your business?

Corporate Reseller	Educational Reseller	Government Reseller	Telstra Reseller
Audio/Visual	Network/VOIP	Wholesale	Consultant
Specialist	Other

Who are your current suppliers?
If you have already spoken to a Multimedia Account Manager, please enter their name

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.

The information provided in this form remains the property of Multimedia Technology Pty Ltd and will not be disclosed to any other company in accordance with the Privacy Act 1988, unless for the collection of monies owed to Multimedia Technology Pty Ltd.