Partner Application

Partner Application Form

Step 1 of 5

20%

Company Details

Name of Company(Required)

Registration no/ID no(Required)

Vat Registration Number(Required)

Email(Required)

Web Address

Postal Address(Required)

Physical Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Telephone

Fax(Required)

Cell(Required)

Bank Details

Name of Bank(Required)

Account Number(Required)

Branch Name(Required)

Branch Code(Required)

Length of time account held at branch(Required)

Years/ Months

Credit Terms Required

Credit Limit

Terms

Eg.30DFS - 30 Days from Statment. COO - Cash on Order

Purchasing Contacts

Name(Required)

Purchasing - Phone(Required)

Purchasing Email(Required)

Accounts Payable Contacts

Name(Required)

Accounts Payable - Phone(Required)

Accounts Payable Email(Required)

This email address will be used to send invoices & statements

Registration with Vendor/s

Vendor Name

Registration Number

Vendors distributed by Maxtec only.

Documentation

You can upload your documentation using the fields below. It will be attached and sent along with the registration form.

ID copy for all active Directors(Required)

Drop files here or

Max. file size: 10 MB, Max. files: 10.

A letter from the bank confirming banking details (not older than 3 months)(Required)

Max. file size: 3 MB.

KRA PIN Certificate

Max. file size: 3 MB.

CR12 Company Certificate

Max. file size: 3 MB.

I, the undersigned,(Required)

First Last

I warrant that the entered information is true and correct. Furthermore that the legal entity/buyer detailed above accepts that all business transactions between same and Maxtec Peripherals (PTY) Ltd will forthwith be governed by Maxtec's Standard Terms and Conditions of Sale (pages 2-3, please click here to view). I also warrant that I am authorised to bind the above buyer/legal entity to this effect.

ID Number(Required)

Upload your signed Terms and Conditions(Required)

Max. file size: 3 MB.

Do you accept the terms & conditions(Required)

Yes

Trade References(Required)

Company Name

Contact Person

Telephone Number

Comments

PLEASE PROVIDE AT LEAST 3 REFERENCES

POPIA Consent(Required)

Provide consent to Maxtec Peripherals (Pty) Ltd:(Required)

To store, utilise and share company, entity and represented individual personal information for the purposes of business transacting within the existing channel programme (i.e Vendor, Distributor, Partner and End User)
To consent to the collection, use and storage of any technical information collected in the process of proposing a solution to your organisation.
To receive emails regarding cybersecurity training and conference events, product updates and product promotions.