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Channel Partner Application

General Details

Company:

Trading Name:

ABN:

Street:

City:

State / Province:

Postal Code / Zip:

Country:

Phone:(inc. area code)

Fax: (inc. area code)

Email:

Web:

Main Contact (Title):

Main Contact (First Name):

Main Contact (Last Name):

Main Contact (Position):

How did you hear about ST Synergy?:

Magazine/Article/Newspaper
ASX
Word of Mouth
Channel Partner/Reseller

If channel partner/reseller, which one?

I can best define my organisation's industry as:

Please write a brief paragraph describing your company (50 - 100 words):

Qualifications

Please describe in detail:

 

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Derrington Holdings Pty Ltd
Suite 2, 17 Foley Street BALCATTA W.A. 6021 Australia
Tel: +61 8 9345 2677
Fax: +61 8 9345 2332
Email: info@stsynergy.com