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Reseller Application Form

Thank you for your interest in Nology and our products.

Nology is a channel focused company and we try our best to protect our reseller channel by ensuring that we only transact with ICT resellers, installers and service providers.

You will be required to attach a copy of your company registration document in this application under the "Documents Required" section.

If neither your company's website nor your company registration documents can prove your company's compliance to the criteria as listed above, please submit your Company Profile as proof. We will not be able to process your application if we cannot confirm compliance to these criteria.

We will process your application as quickly as possible, however please note that it may take up to two business days or longer if we cannot confirm compliance to the required criteria from the information and documents provided.

Once your application has been approved, we will send you a confirmation email and provide you with your account number and our latest pricelist.

Please note that this is not an application for credit facilities, but to confirm your company information and register you as a reseller on our system.

Please complete the application form below.


Fields marked with * are mandatory.



Company Information

Registered name of business:*
Trading name of business:*
Type of business:*
Company registration no.:*
Is your company VAT registered?*
VAT registration no.:*

Business Address & Contact Details

Please complete the Head office details below (*Required).

Head Office Details:

Physical address: (Head office)*
Physical address: (Head office) (2)
City: (Head office physical)*
Province: (Head office physical)*
Area code: (Head office physical)*
Country: (Head office physical)*
Postal address: (Head office)*
City: (Head office postal)*
Province: (Head office postal)*
Area code: (Head office postal)*
Country: (Head office postal)*
Telephone no: (Head office)*
Fax no: (Head office)*
Primary email address: (Head office)*
Re-type email address: (Head office)*

Branches

If you would like to add branches, please use the check buttons to select more branches and complete these fields.

Branches:

Branch 1 Details:

Physical address: (Branch 1)*
Physical address: (Branch 1) (2)
City: (Branch 1 physical)*
Province: (Branch 1 physical)*
Area code: (Branch 1 physical)*
Country: (Branch 1 physical)*
Postal address: (Branch 1)*
City: (Branch 1 postal)*
Province: (Branch 1 postal)*
Area code: (Branch 1 postal)
Country: (Branch 1 postal)*
Telephone no: (Branch 1)
Fax no: (Branch 1)
Email address: (Branch 1)
Contact person: (Branch 1)

Branch 2 Details:

Physical address: (Branch 2)*
Physical address: (Branch 2) (2)
City: (Branch 2 physical)*
Province: (Branch 2 physical)*
Area code: (Branch 2 physical)*
Country: (Branch 2 physical)*
Postal address: (Branch 2)*
City: (Branch 2 postal)*
Province: (Branch 2 postal)*
Area code: (Branch 2 postal)*
Country: (Branch 2 postal)*
Telephone no: (Branch 2)
Fax no: (Branch 2)
Email address: (Branch 2)
Contact person: (Branch 2)

Branch 3 Details:

Physical address: (Branch 3)*
Physical address: (Branch 3) (2)
City: (Branch 3 physical)*
Province: (Branch 3 physical)*
Area code: (Branch 3 physical)*
Country: (Branch 3 physical)*
Postal address: (Branch 3)*
City: (Branch 3 postal)*
Province: (Branch 3 postal)*
Area code: (Branch 3 postal)*
Country: (Branch 3 postal)*
Telephone no: (Branch 3)
Fax no: (Branch 3)
Email address: (Branch 3)
Contact person: (Branch 3)
Website url (please leave field blank if you do not have a website):
Nature of business:*
Core market focus:*
Number of employees:*
Business established date: (YYYY-MM-DD)*
Where did you hear about us?:*
Where did you hear about us (Other):*
Have you spoken to a Nology sales representative?:*
Please select the sales representative:*
Please select the sales representative (Other):*
Which products/brands are you most interested in:*
Preferred trading currency (if non-resident company):
Which other trade suppliers are you registered with?*


Directors / Partners / Members / Owner Details

Full name: (1)*
ID no: (1)*
Designation: (1)*
Address: (1)*
Full name: (2)
ID no: (2)
Designation: (2)
Address: (2)
Nology is committed to Black Economic Empowerment and as part of this commitment Nology contributes annually to the Economic Development of selected Black Owned Businesses. For potential consideration of such contribution please indicate if you have:

Accounts / Buyer / Technical Details

Accounts contact name:*
Accounts contact surname:*
Accounts email:*


Technical contact name:*
Technical contact surname:*
Technical email:*

Contacts to receive the monthly price list and specials:

Additional name: (1)
Additional surname: (1)
Additional email: (1)


Additional name: (3)
Additional surname: (3)
Additional email: (3)

Buyer contact name:*
Buyer contact surname:*
Buyer email:*


Email address for quotes & invoices:*
Additional name: (2)
Additional surname: (2)
Additional email: (2)


Additional name: (4)
Additional surname: (4)
Additional email: (4)

Documents Required

Applicable to Close Corporations, Companies and Trusts:
Entity's Registration documents
VAT registered customers (if applicable):
• VAT103 – Official notice of registration, OR Tax clearance certificate

Applicable to Individual / Sole Proprietors:
Copy of ID document of the applicant
VAT registered customers (if applicable):
• VAT103 – Official notice of registration, OR Tax clearance certificate

NOTE: Please ensure there are no special characters in the
name of your attachment/s.

Cipro / CIPC certificate:*
Proof of VAT registration:*
Additional documents:

Acknowledgment

Agree*
(Full Name),*

hereby confirm that:

• I am duly authorised to enter into this agreement for and on behalf of the applicant, and that the information contained in this form is true and correct.
• I have read and understood the standard Terms and Conditions of sale and accept them as binding upon the applicant. I furthermore agree to check Nology's Terms and Conditions of sale periodically for changes that may have taken effect from the date of registration.
• I have read and agree to the processing of personal information in terms of the Protection of Personal Information Act, 4 of 2013 ("Act")
• I understand that this is a Reseller Registration only and not a Credit Application.

Verification:

About Nology

Founded in 2001, Nology is a specialist value-added distributor of converged IP solutions to service providers, network operators, systems integrators and resellers across Southern Africa.

Products

Gauteng Office

Icon Mail sales@nology.co.za

Icon Phone +27108240040

Icon Home Unit 4 Louwlardia Business Park
122 Bavaria Road, Centurion
Gauteng, South Africa, 0157

Cape Town Office

Icon Mail cptsales@nology.co.za

Icon Phone +27108240044

Icon Home Unit 2 Garnet Park
6 Drill Avenue, Montague Gardens
Cape Town, South Africa, 7441

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