Reseller Application Form

Online Application Form
Please complete the following to assist Naissus Australia in evaluating your company to become a Naissus Australia authorized reseller.


    Select Application Form Type:

    Will you be signing up as a Naissus Australia Distribution Partner*:

    Will you be reselling the products purchased from Naissus Australia?:

    Will you be signing up as a Naissus Australia Cloud Partner?*:

    Select Application Type *

    Business Details

    Select Postal Address:

    Financial Terms & Business Structure

    Anticipated Credit Terms*:

    Is your business a trustee of a trust?:

    Contact Names

    Director/Proprietor * (All details are required)

    Other Contact Names

    Manager * (All Manager details are required)

    Other Contact Names

    Purchasing Officer/Accounts Payable * (All names and details are required)


    Accounts Payable * (All names and details are required)

    Additional Business Details

    Product Focus: *

    Principle Product Focus: *

    Which Markets Does Your Business Operate within: *

    Select Geographical Area *

    Authorised Courier Companies * (All names and details are required)


    Privacy acknowledgment and consent

    The Customer acknowledges and understands that:
    (a) the personal information provided in Reseller Application form is collected and will be used, disclosed and otherwise handled by Naissus for the purpose of assessing the application for, and otherwise administering, a dealer account, and for any other purpose set out in Naissus privacy policy;

    (b) Naissus, in administering the Application, will not disclose the personal information to third party service providers, Naissus’s related bodies corporate, business partners, contractors and consultants, insurers and professional advisors, regulatory bodies, and/or professional advisors and service providers as nominated by you; and

    (c) without the information required by the Reseller Application Form, Naissus may be unable to process this application or otherwise may be limited in the products and/or services it can offer, if any; and

    (d) Naissus’s privacy policy contains information about how individuals may access or correct their personal information held by Naissus, or complain about Naissus’s handling of their personal information.

    By submitting the application form (including by signing using any form of digital or electronic signature) or by otherwise confirming your acceptance of the terms set out in this form (including by submitting a completed application form to Naissus) we:

    (a) hereby apply to be a customer of NAISSUS CORPORATION PTY LTD (Naissus);

    (b) confirm that all goods and/or services bought are for resale or marketing and promotional purposes only;

    (c) warrant and undertake that the information provided in this application is accurate to the best of our knowledge;

    (d) confirm and agree that all Terms and Conditions contained herein are fully understood and agreed to and that we will be legally bound by the Terms and Conditions contained herein; and

    If you sign/submit or otherwise confirm acceptance of the terms set out in this form on behalf of an entity, you represent and warrant to us that you have full authority to do so on behalf of the entity and to legally bind the entity.

    I Agree to the Terms & Conditions: