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	New South Wales Aust. Capital Territory Victoria Queensland South Australia Western Australia Tasmania Northern Territory      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