eScuba Dealer Application - Register today

eScuba Dealer Application
If you are already a Dealer, you can login here.

Please choose the manufacturer brands you wish to distribute:

Company Name:		(This must be the full legal title of the company.)
ABN Number:
Billing Address:
Address:
City:
State:
Post Code
Day Phone:
Evening Phone:
Fax No.:
Shipping Address:
Address:
City:
State:
Post Code:
Day Phone:
Email Address:		(Will be used as your Login username)
Select Password:
Confirm Password:
Website:
Business is:	Propriertorship Partnership Corporation

List of directors or proprietor
Name:		Title:
Name:		Title:
Name:		Title:

Established Business since (year):
Business at this location since (year):
Store Property is:	Rented/Leased	Owned
Number of store locations:
My showroom normally stocks the following types of products:
Check all that apply Dive equipment and related accessories Marine equipment and related accessories Outdoor equipment and related accessories Photography equipment and related accessories Consumer Electronics equipment and related accessories Other - Describe:

My business is an authorized dealer for these major brands:

My business is an authorized dealer for these major camera brands:

My business has authorized Atomic Repair Technicians:

yyyy

Repair Tech Name:

Certified End Date:

Repair Tech Name:

Certified End Date:

Repair Tech Name:

Certified End Date:

Number of employees:
My business sells products: (Check all that apply)
In my store showroom On my company website
My business accepts the following methods of payment
Check all that apply Cash Visa/Mastercard American Express Check PayPal [or similar]
Preferred shipping method (from EScuba to your business):
Ground 3-Day 2-Day
Preferred payment method (for invoices):
COD Visa/Mastercard
Preferred method of contact:
Email Phone
Dealer Policy:


I confirm I have read and agree with the dealer policy and the above dealer application information is true and correct By typing you name below you confirm you have read and agree with the dealer policy and the above information is true and correct:

All prices are in AUD and inclusive of GST (10%)

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