DESCRIPTION OF BUSINESS

*Date business established:

*Business trading name:

*Registered business name:

*Registered business address inc. suburb, state & postcode:

*Length of time at this address:

*Business phone inc. area code:

*Business fax inc. area code:

*E-mail address:

*A.C.N/A.B.N.

Billing address (if different from Business Address):

*Business street address inc. suburb, state & postcode:

Shipping address inc. suburb, state & postcode (if different to business street address above) :

Documents must be fully completed before an account is opened and pricing quoted. We do not want to delay your application.

*Will you be reselling the product that you purchase from Globaltech?

Yes: No:

*Have you had an account with Globaltech before?

Yes: No:

If yes, under what name?

*Where did you find out about Globaltech?

WHICH CATEGORY BEST DESCRIBES YOUR COMPANY'S BUSINESS?

*Please choose:

If other please specify:

WHICH CATEGORY BEST DESCRIBES YOUR COMPANY'S OWNERSHIP AFFILIATION?

*Please choose:

If other please specify:

TOTAL MONTHLY TELECOMMUNICATIONS PURCHASES

Please choose:

RESELLER AGREEMENTS

Which of the following manufacturers do you have authorised reseller agreements with, any? (Please tick all that apply and list authorisation numbers)

Ericsson:

Plestel:

Omni:

Panasonic:

Cellnet:

Siemens:

Aria:

Alcatel:

MARKETS

What percentage of your sales are to the following markets? (total should be 100%)

Small to medium size business:

Enterprise/large business:

End-users:

Government:

Other:

EMPLOYEES

How many employees does your company have?

Please choose:

TOTAL YEARLY SALES

What were your company's total gross sales last year?

*Please choose:

CUSTOMER LEASING OR RENTAL

Do you currently offer a leasing program to your customers?

Yes: No:

If yes, through which company?

DETAILS OF ALL PROPRIETORS OR DIRECTORS (Compulsory)

*Full name 1:

*Full address inc. suburb, state & postcode 1:

*Phone number 1:

Full name 2:

Full address inc. suburb, state & postcode 2:

Phone number 2:

Full name 3:

Full address inc. suburb, state & postcode 3:

Phone number 3:

IF COMPANY, LIST ALL DIRECTORS. IF PARTNERSHIP, LIST ALL PARTNERS

What type of trading account do you require? Please choose.

Credit (a credit account application form will be sent after this form is received):

Cash in advance:

Please be advised that a credit account can only be authorised after your trading revenue exceeds $2000.

Customer agrees to notify Globaltech Pty Ltd of any change in ownership of its business, as set forth herein by certified mail to Globaltech Pty Ltd:

PO Box 1703
Canning Vale
WA 6970
OR PLEASE RETURN CHANGES BY FAX TO (08) 9256 2121.

Globaltech Pty Ltd reserves the right to terminate without cause Customer's right to purchase products and services on credit or to vary the credit terms in respect of Customer. Customer consents to Globaltech Pty Ltd investigating the credit history of Customer through credit reporting agencies and other methods of sharing credit information. NB. Trusts will not be given Credit. Directors guarantee must be requested. Customer is required to furnish Globaltech Pty Ltd with their audited/certified accounts. Customer's authorised representative (Director/Proprietor/Partner):

*Full name:

*Position:

Signature:

*Date:

eg: dd/mm/yyyy

Full name:

Position:

Signature:

Date:

eg: dd/mm/yyyy