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:

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 SeaLife invoices):
COD Visa/Mastercard Net 30 days

Preferred method of contact: Email Phone

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: