Become a Dealer
ONLINE APPLICATION
Telstra Master Distributor
Channel Partners Commercial Case
(
*
) denotes required field
Application Information
How did you hear about ICT?
*
ARN
CRN
Web search
Word of mouth
Vendor
Other
Who is your ICT Field Representative?
*
What type of Dealer would you like to become?
*
Full ICT Telstra Dealer
ICT Dealer
Are you an existing BigPond Dealer?
*
yes
no
New Applicant Details
What is your business structure?
*
Sole Proprietor
Partnership
Company
Trust
Years Trading:
*
0
1
2
3
4
5
6
7
8
9
10+
What is your annual sales revenue?
*
How many locations do you have?
*
Type of premise:
*
Retail
Office
Retail & Office
Home Office
Mobile Office
Other
Would you like a credit A/C?
*
yes
no
Are you a M’soft Partner?
*
yes
no
Entity Details
Entity Name:
*
ABN:
*
Trading Name:
*
ACN:
*
Telephone:
*
Fax:
*
Web address:
*
General Email:
*
Address:
*
(no PO Box addresses)
Suburb:
*
State:
*
QLD
NSW
ACT
VIC
TAS
SA
WA
ALL
NT
Postcode:
*
Director's Name:
*
Mobile number:
*
Email Address:
*
Drivers license no.:
*
Main Contact Name:
*
Main Contact Phone:
*
Main Contact Email:
*
Accounts Contact:
*
Accounts Phone:
*
Accounts Email:
*
Company Profile & Background
Applicant Description - Types of Products and services provided by the company:
*
Supplier References
1. Authorised Dealer for:
*
Contact:
*
Phone:
*
2. Authorised Dealer for:
*
Contact:
*
Phone:
*
3. Authorised Dealer for:
*
Contact:
*
Phone:
*
Trade References (all three references must be completed)
1. Accountant:
*
Contact:
*
Phone:
*
2. Bank:
*
BSB#:
*
Account #:
*
3. Landlord:
*
Contact:
*
Phone:
*
Authorisation
By completing this I give the Consents and make the Declarations on behalf of the applicant.
Name:
*
Email:
*
Date:
*
I agree to the ICT Distribution's Terms & Conditions (
click here
to view)
Simple I.D.