Partner Program Application Form

  1. Please complete all fields in this form, print the form and sign where required.
  2. Send the completed form to Netsell Internet, PO Box 158 St Peters LPO NSW 2044

company details

 

Company Name

ABN

Contact Name

Postal Address

Suburb/Town

State

     Postcode:

Telephone
Include area code

Facsimile
Include area code

Email Address

Website Address

details of your client (if applicable)

 

Website Address of
Your Client

  • The initial agreement will run for a period of 12 months from the date of acceptance.
  • All material and software provided by Starnex Holdings-Netsell Internet is for the exclusive use in the manner for which it is intended.
  • Due to the changeable nature of the Internet, we reserve the right to amend this agreement with notice to our clients.

We look forward to a long and beneficial partnership.
Complete below after printing

Signature


Print Name


Company


Date


IMPORTANT: The above information is held in the strictest confidence and will not be released to, or used by, any individual or company other than Starnex Holdings-Netsell Internet and for no use other than in the management of the Netsell Internet Partner Program.
 

Netsell Internet, a division of Starnex Holdings
PO Box 158 St Peters LPO NSW 2044 Australia