Partner Application

Application details

To be completed by an authorised representative of your organisation.

User Registration

"*" indicates required fields

Phone

This field is for validation purposes and should be left unchanged.

Already a customer?*

Yes

Your details

User's Name*

First Last

Email Address*

Confirm Email Address*

Create your own Password*

Enter Password Confirm Password

12 or more characters: not yet
Passwords match: not yet

Your company

Company Name*

Trading Name

Branch Name

Company Registration Number*

Main Telephone*

Are you VAT Registered?*

Yes

VAT Registration Number*

Address*

Street Address Address Line 2 City State / Province / Region Postal Code Country

Commission payments

Commission Structure*

Group A – Earn full commission

Group B – Earn half commission and allocate half as a discount to members / customers

Group C – Earn no commission and allocate the full discount to members / customers

Commission Notifications

Same as User’s

Email (notification for commission payments)*

First Name, Last Name (for notification for commission payments)*

First Last

Bank Name*

Universal Branch Code*

Other Bank

Bank Hidden

Account Type*

Current/Cheque Account

Savings Account

Transmission Account

Bank Account No

Bank Account Number*

Account Name*

Bank Account Confirmation*

Upload Bank Account Confirmation Letter (not older than 3 months)

Max. file size: 8 MB.

Agreement

I have read and agree to the terms of the Partner Agreement available here.

I have read and agree to the terms of the Partner Agreement available here.*

I agree.