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eScuba Dealer Application

Please choose the manufacturer brands you wish to distribute:

Sealife
Ideations
Submersible Systems Spare Air
Akona
Sherwood
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:

List of directors or proprietor

Name:
Title:
Name:
Title:
Name:
Title:
Established Business since (year):
Business at this location since (year):
Store Property is:
Number of store locations:

My showroom normally stocks the following types of products:

Check all that apply

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 Sherwood / Dive Alert / Spare Air Repair Technicians:
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

My business accepts the following methods of payment

Check all that apply

Preferred shipping method (from eScuba to your business):

Preferred payment method (for invoices):

Preferred method of contact:

Dealer Policy:


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

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eScuba Pty Ltd
Click here for Repairs & Service Address
Billing Address:
PO Box 785
Milsons Point, NSW 1565 Australia

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