Reseller Registration

name

Company Details

Company Name or Dealership

Trading Name

Resale Certificate

Company Website

Business Phone (international format)

Fax (international format)

Street

City / Suburb

Postcode / Zip

State

Country

Mailing Address

Same as Business Address

Street

City / Suburb

Postcode / Zip

State

Country

Contact Details

Salutation

First Name

Last Name

Position

Email Address

Phone Number (international format)

Mobile Number (international format)

Current Manufacturer or Distributor Reference Details

To facilitate the validation of your application for Alloy Dealer Registration, Alloy will need to verify data which establishes your bona fides as a reseller of IT products and/or services. Please complete this section in order to facilitate this process. All information entered here is treated with confidentiality.

Supplier 1

Company Name

Contact Name

Phone Number (international format)

Supplier 2

Company Name

Contact Name

Phone Number (international format)

Additional Information

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General Comments

By submitting this form, you give Alloy consent to use the information to validate your registration.

Information for Resellers

Information for Resellers

Reseller Registration

Supplier 1

Supplier 2