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Reseller Registration Form
Reseller Registration Form
This form is to open a New Account with A.P. Technologies Pty Ltd & does not provide Credit Terms. The A.P. Technologies policy is to only deal with Education, AV/IT resellers and integrators who are either a registered business or company
Client/Account Information
Business name
ABN#
*
ABN or ACN
Trading Name if different
Street address
Street address line 2
City
State
NSW
VIC
QLD
WA
TAS
NT
Post Code
E-mail address
LinkedIn/online profile url
Primary Contact
Accounts Contact
Billing Address
Same as above
Billing Address
Contact person
Business name
Street address
Street address line 2
City
State
NSW
VIC
QLD
WA
TAS
NT
Zip Code
END Section
Shipping Address
Same as above
Shipping Address
Contact person
Business name
Street address
Street address line 2
City
State
NSW
VIC
QLD
WA
TAS
NT
Zip Code
END Section
What Brands from A.P. Technologies are you interested in?
Epiphan Video Recorders / Streamers
Swivl Robot
Minrray PTZ Camera / Controller
PUAS PTZ Camera Controller
Which describes your company best
Education Reseller
Audio / Visual
Government Reseller
Medical Reseller
Corporate Reseller
Specific Registration Requests/Details
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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 A.P. Technologies Pty Ltd
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