AVA Distribution Reseller Registration Form

Thank you for choosing to become and AVA registered reseller. Please complete the form below and click Submit. Please note, completing the application does not automatically grant approval. Fields marked with an * are required

Business Details

Company Name*

Trading Name*

ABN Number*

Date Business Started *

Contact Name*

Contact Phone Number*

Contact Mobile Number*

Website*

Email Address*

Delivery Address

Street Address* Postcode* Suburb* State*

Postal Address

Street Address* Postcode* Suburb* State*

Accounts Contact Name*

Accounts Contact Email Address*

Building Type where this business operates from

You may tick more than one if applicable

Home Shop Office Warehouse

In which of the following categories are you actively involved?