I.STORE (CT&T) COMPUTERS        
 149 SPRINGVALE ROAD, NUNAWADING,  VIC 3131
TEL: (03) 9894 8466        FAX: (03) 9894 7781

 388 LONSDALE STREET, MELBOURNE, VIC 3000
TEL: (03) 9670 9686        FAX: (03) 9670 9687

DEALER APPLICATION FORM
CUSTOMER HISTORY  (ALL CUSTOMERS TO COMPLETE)

Company Name: ______________________________________________	ABN NO: ________________

Trading As: _______________________________________________________________________________

Address: _____________________________________________________	Post Code: _______________

Phone No.: ________________________________	Fax No.: _____________________________

Email address: _____________________________________________

Registered Office: _____________________________________   (a copy of Business Registration is required)

Business Style:	  Sole Trader	 Partnership	 Pty. Ltd. without trust
	  Trust 	 Public Co
Business Address:	  Owned	 Leased
Date of Incorporation: ______/_____/_______
Name(s) and Address(s) of Sole Trader, Partners, Directors and Spouses. 
Full Name: ______________________________ 	Full Name: ______________________________
Address: ________________________________	Address: ________________________________
                ________________________________	                ________________________________
State: _________           Post code: ___________	State: _________           Post code: ___________			   
Phone No: ______________________	Phone No: ______________________

Please state whether applicant is trustee for any trust
Full name of Trust________________________________________________________________________
Customers to supply a copy of memorandum and articles of association and copy of stamped trust deed with this application.
Trade References   (Please supply at least 3 Computer Supplier references, other than Associated Companies)
Company: ______________________________________	Phone No: ________________________
Contact Person: _________________________________
Company: ______________________________________	Phone No: ________________________
Contact Person: _________________________________
Company: ______________________________________	Phone No: ________________________
Contact Person: _________________________________

The information I have given is said to be TRUE otherwise I.Store(CT &T) Computers may refuse your application.  

Signature: __________________________________________	Date: ______/______/______

Name (Please print): _________________________________