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Reseller Application


You must select a business type.
Enter no more than 200 characters.
You must enter the name of your business.
Enter no more than 200 characters.
You must enter the business delivery address.
Enter no more than 1000 characters.
You must enter the post code.
You must enter a valid post code.
You must enter the business postal address.
Enter no more than 1000 characters.
You must enter the post code.
You must enter a valid post code.
You must enter a business phone number.
You must enter a valid phone number.
Enter no more than 20 characters.
You must enter a valid fax number.
Enter no more than 20 characters.
You must enter an email address.
You must enter a valid email address.
Enter no more than 100 characters.
You must enter a contact name.
Enter no more than 100 characters.
You must enter a bank and branch.
Enter no more than 100 characters.
You must enter a GST number.
Enter no more than 20 characters.
Enter no more than 20 characters.
You must enter the type of business.
Enter no more than 200 characters.
You must enter how long you've been in your present business.
Enter no more than 100 characters.
(Please note: This figure is subject to approval)
You must enter the credit limit you require.

TRADE REFERENCES: List only businesses you have traded with for at least 6 months. Exclude service accounts (eg electricity, petrol, oil & gas).
1.
You must enter the companies name.
Enter no more than 200 characters.
You must enter a contact at the company.
Enter no more than 200 characters.
You must enter the contacts phone number.
You must enter a valid phone number.
Enter no more than 20 characters.
2.
You must enter the companies name.
Enter no more than 200 characters.
You must enter a contact at the company.
Enter no more than 200 characters.
You must enter the contacts phone number.
You must enter a valid phone number.
Enter no more than 20 characters.
3.
You must enter the companies name.
Enter no more than 200 characters.
You must enter a contact at the company.
Enter no more than 200 characters.
You must enter the contacts phone number.
You must enter a valid phone number.
Enter no more than 20 characters.

Aurora Pacific Ltd will use any personal information on this form for credit, administration, and service. You consent to receive emails from Aurora Pacific Ltd related to those purposes. If full information is not provided your application for credit may be declined. You have the right of access to, and to ask for correction of personal information.

You authorise any person or company to provide Aurora Pacific Ltd with such information as it may require in response to credit and/or other enquiries. You further authorise Aurora Pacific Ltd to furnish to any third party details of this application and any subsequent dealings that you may have with it as a result of this application being actioned by you and in relation to any account you may have with it. You understand that Aurora Pacific Ltd may register a security interest over any goods it supplies to you.


You must declare the above is true and correct.
You must warrant you are solvent and able to pay debts.
You must agree to the Terms of Trade.