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To become an Authorised Mindflux Reseller, please fill out the form below with the appropriate details and press the 'Submit Application' button.
Once your application has been processed, a Mindflux representative will be in contact with you to discuss the details of our reseller program.

 

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Authorised Reseller Application Form

Company (Trading) Name:
Business Name(s):
Company Type: Public company  Company  
Partnership  Sole Trader
Sales Type: Shopfront  Consulting  E-commerce
ABN: 
Contact Name(s):
E-mail address:
Website address (URL):
Phone No:
Fax No:
Marketing used: TV  Radio  Newspaper
Internet  Fax  Direct Mail
Street Address:
Postal Address:
(if different)
Trade References:
(for credit terms only)
Company Date started Contact Phone No.
Further info and/or Comments:
   
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