Adimex Dealer / Credit Account Application

Primary Contact

*First Name

*Last Name
*Email Address

*Job Title
*Mobile

*Telephone

Company Details

*Company Name

*ABN
*Years in Business

*No of Staff
Fax

*Website
*Street Address
*City

*State/Province
*Zip/Postal Code

*Country

*Owner/Director/Proprietor

*Purchasing Officer
Additional Contacts (1)

Job Title
Additional Contacts (2)

Job Title
*Products you are interested in selling:
*Please list the types of customers you sell to:
*Please indicate your company’s areas of interest:
- Production
- Post-Production
- Animation and Visualisation
- Streaming Encoding and Transcoding
- Storage Backup and Archive
- Audio Video Integration
*I confirm that the products will only be purchased for resale
*I have read and agree to Adimex Terms and Conditions

Trade References

*Company Name (01)

*Contact Name

*Telephone
*Company Name (02)

*Contact Name

*Telephone
I would also like to apply for a Credit Account Credit Account approval can take up to 15 working days days. By applying for a Credit Account you authorise Adimex to obtain any trading or other information from the referees that may be required to support the Credit Account application. If the Credit Account is approved, you will be notified in writing as to the terms of Credit Account. The Adimex Dealer Application may be approved prior to the Credit Application and at that time you will be able to place orders with Adimex using credit card or direct deposit.

Credit References

Required if applying for a Credit Account

Company Name

Contact Name

Telephone

Login Information

*Password

*Confirm Password

* Required Fields