| Please ensure you fill
this application form in completely and clearly. |
| 1. Choose a Login
Name: |
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| 2. Choose a Login
Password: |
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| 3. Confirm
Password: |
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| 4. Are you an
authorised dealer?: |
Yes `
No ` |
| 5. Company
Name: |
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| 6. Trading
As: |
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| 7. Dealer
Principal: |
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| 8. Authorised
Purchaser: |
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| 9.
Physical Address: |
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| 10.
Postal Address: |
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| 11. Phone
Number: |
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| 11a. Mobile Phone
Number: |
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| 12. Fax
Number: |
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| 13. Company Email
Address: |
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| 14. Website
Address: |
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| 15. What cars are
you interested in importing?: |
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| 16. How
did you hear of us?: |
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