Authorised Reseller Application

Organisation Details
Company/Legal Name:
Trading As:
Trading Since:
Phone:
ABN/VAT Number:
Alternate Phone:
Shipping Address
Street Address Line 1:
Street Address Line 2:
Suburb:
Province/State:
Country:
Post/ZIP Code:
Billing Address SAME AS SHIPPING ADDRESS ABOVE
Street Address Line 1:
Street Address Line 2:
Suburb:
Province/State:
Country:
Post/ZIP Code:
Contact Details (Owners, Partners, Directors, Managers and/or Buyers)
Full Name Capacity/Role Contact No. Email Contact #1 Contact #2 Contact #3 Contact #4 Contact #5
E-Commerce and Social Networking Pages
Website Address:
Instagram Page:
Facebook Page:
eBay ID:
YouTube Channel:
Other sites:
Market Positioning
Number of staff employed:	<select> 5 or less Between 5 and 15 Between 15 and 30 More than 30
Estimated annual purchase of Nolathane products:	<select> Less than $15K $15K - $40K $40K - $75K More than $75K
Are you or have you ever been affiliated with organisations that distribute Nolathane products?	Yes No
If Yes, please provide details:
Which other leading brands are you currently authorised to sell? (list 5 for reference)
Type of Business: (tick all that apply)	Brick & Mortar Retailer Brick & Click Retailer Click-Only Retailer E-Commerce Retailer Distributor
Vehicle Specialisations: (tick all that apply)	Jap Euro Aussie Prestige Hot Hatch Muscle 4WD
Events attended or of interest: (tick all that apply)	Track Rally Drift Show 'n Shine Drag Skidpan
If you are a Suspension Centre or Performance Tuner, does your location have the following facilities?
Hoist	Yes No
Wheel Alignment	Yes No
Dyno	Yes No
If you sell Online, do you have the following?
A current Shipping & Returns Policy?	Yes No
Qualified staff who can offer technical support on Nolathane products?	Yes No
A landing page dedicated to Nolathane products?	Yes No URL
Disclaimer: Completion of the "Authorised Reseller Application" form does not guarantee automatic recognition as a Nolathane authorised reseller or Performance Partner nor is it an automatic “Account Application". A representative shall contact you should further information be required and Nolathane reserves the right to reject any application without comment as well as remove the reseller from the authorised list at its own discretion.
Contact details of person completing this application
Full Name:
Capacity:
Contact No:
Email:
Date:
In completing this "Authorised Reseller Application" form you agree to the following:
The information provided above is true and complete to the best of your knowledge: Yes
In your capacity, you have appropriate authority to complete this application: Yes
Nolathane Branding and Logos are used in accordance with the Branding Guidelines Version 1.1: Yes
Contacts provided are automatically registered to our e-communication database: Yes
Agree to the terms set out in the Redranger Authorised Reseller Policy: Yes
Thanks for taking the time to complete this form - and thanks for using Nolathane products.