Reseller Application

Reseller Registration

Note: If you are already a registered reseller with Bluechip Infotech and would like to apply for Web Access, click here
If you are not a registered reseller with Bluechip Infotech, complete the form below.

Instructions: Fill out the form and click the Submit Button. Items marked with a * are compulsory.

BUSINESS DETAILS:
Business Name:	*
Bluechip Infotech company policy is to only deal with computer resellers who are either a registered business or company. As such, any registration that does not include a valid ACN or RBN will not be processed, with no further correspondence. An ABN is not sufficient.
ACN or RBN: Please type the number and select ACN or RBN button	* (7 to 30 characters allowed) ACN or RBN
Registered Office Details:
Street Address: Suburb\ State\Postcode Country	***
Phone/Fax	*/
Trading Name (if applicable):
Trading Address Details:
Street Address: Suburb\ State\Postcode

LEGAL STRUCTURE:
Public	Private	Trust	Partnership	Sole Trader

BUSINESS DESCRIPTION: (Please tick)
Computer Reseller Store		Systems Integrator
Value Added Reseller (VAR)		Original Equipment Manufacturer (OEM)
Other

FULL NAMES AND ADDRESSES OF DIRECTORS, PROPRIETORS OR PARTNERS
(1)
Name:	*
Address:	*
Suburb:	*
Post Code:	*
A/H Tel:	*

(2)
Name:
Address:
Suburb:
Post Code:
A/H Tel:

(3)
Name:
Address:
Suburb:
Post Code:
A/H Tel:

(4)
Name:
Address:
Suburb:
Post Code:
A/H Tel:

Please Note:

New Cash Account Customers requesting delivery of order totalling more than $1,000.00 are advised that the following payment options are available for the first two / three transactions:

Telegraphic Transfer
Bank Cheque
Cash
Company Cheque (goods to be released upon clearance of funds).

PURCHASING CONTACT:
Name	*
E-mail	*
Phone/Fax	*/

Please Note: You only need to press the Submit Button Once

Revised: 20 May, 2004