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