Common Contracts

NEW RETAILER AGREEMENT FORM

Retailer Agreement • February 16th, 2018

• Contract Type
  Retailer Agreement
• Filed
  February 16th, 2018

Retailer details Trading Name ……………………………………………………………………………….. Company or Business Name ……………………………………………………………………..…………. ABN or ACN …………………………………………… Delivery Address ……………………………………………………………………………….. ……………………………………………………………………………….. State: ………………………… Postcode: ………………………Business Address ………………………………………………………………………………..(if different from Delivery Address)……………………………………………………………………………….. State: ………………………… Postcode: ………………………Telephone Number (business) ………………………………….. Email:……………………………… Facsimile Number (business) ………………………………….. Epay / Touch A/C No:…………….. Customer ID Nº. (if applicable) ………………………………….. Epay / Touch Terminal ID:……….. Ordering To order Products: Fax: 07 5446 1755E-mail: sales@simconnect.com.au Phone: 1300 378 390 Notices to SimConnect National Pty Ltd SimConnect National Pty Ltdmust be sent to: PO Box 586 Coolum Beach Qld 4573 Payment Option Direct Debit:  YES  NO If Yes, please complete a Direct Debit/Payment Authority FormAccount:  YES  NO If Yes, please complete a