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* Mandatory

    Company Details

* Trading Name
(please specify)
   
* Company Name
or Holding Company
* ABN
* Street Address
* Suburb
* State
* Post Code   
* Postal Address As Above
* Suburb
* State
* Post Code   
* Store Phone
(STD)     (Number)
Store Fax
(STD)     (Number)
WebSite address Http://
* How many sales staff work at this store?
* Is this the head office or branch office for this company? Head Office
Branch Office
Store
* How many stores/outlets does your company have in Australia?
* Briefly describe your store/company and what it sells
 
    Your Details

* Your Name
   
   
(Title) (First Name) (Surname)
* Position in Company
* Direct Phone
(STD)     (Number)
Mobile
* Email Address
We will send you an email to validate your channel Epson membership
* Password
* Confirm Password
    Store Owner / Authorised Store Manager's Details

   I am the store owner/manager as above 
* Name
   
   
(Title) (First Name) (Surname)
* Position in Company
* Direct Phone
(STD)     (Number)
Mobile (no spaces)
* Email Address
 
   * Distributor Details

 
Corporate Consumables () Epson Distributor (NI)
EPSON New Zealand Ltd (AKL) Ingram Micro - Auckland ()
Ingram Micro - Chch () Ingram Micro - Wellington ()
Morning Star () Nutech ()
Renaissance () Sektor NZ (Auckland)
Other Distributor
(Distributor's Name, Address and Phone no.)
Name
 
Address (Line1)
  (Line2)
Suburb
State
Post Code   
Direct Phone STD Code and Number (no spaces)
 
    Epson Products Re-Sold

Epson Products * Which Epson products do you sell?
 

Do you want your store listed on Epson's where to buy website? 

 
    Electronic Message Subscriptions

Periodically, Epson Australia communicates with its customers electronically, usually by e-mail, to inform them about matters such as new product information, special discounts and exclusive offers.

At anytime, you can SUBSCRIBE to or UNSUBSCRIBE from our e-mail topic lists.

Please note as a Channel Epson member, It is important that receive email from Epson, particularly bulletins as they contain price changes and new product info.

To SUBSCRIBE
If you would like to receive information via e-mail on any topic listed below, please select the "Yes" option alongside that topic.

Topics:
Special Discounts & Exclusive Offers Yes or   No
New Product Releases Yes or   No
Company News & Information Yes or   No
Promotions & Competitions Yes or   No
Bulletins Yes or   No
POS Update Newsletter Yes or   No
POS Secure Web Updates Yes or   No
POS Bulletins Yes or   No
Prographics Bulletins Yes or   No
Cancel Promo Entry Yes or   No
Projectors Only Yes or   No
Emailed Promo Entry Yes or   No
New Price List Posted Yes or   No

Change of Preferences
If at a later date you would like to update or edit your selected e-mail topics, simply return to this page by clicking on the "Unsubscribe" link at the bottom of the www.channel.Epson.com.au homepage.

Solicited E-mail Responses
Please note that if you send Epson an e-mail query, make an online purchase, ask for technical support or enter an online competition or promotion, we will automatically send you an email reply or confirmation (as the case may be), even though you may have unsubscribed from all the above topics.

     New Application Application Declaration

I wish to register my store on the Epson channel website and I have read, understood and agree to the terms and conditions and the privacy policy of this website. I declare that all information provided on this application is true and correct.
 
 
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