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AU Nexus Pools Dealer Application Form

Business Entity Name

(full legal company name, Trust or individual’s name if not company)

Registered Company Name

Type of Entity

If Trust, entity administering Trust and Trading entity:

ABN (AUS Applicants)

ACN (AUS Applicants)

Company Office Holder’s Details

Company Owners Name and Officeholder Title (shareholders/members/partners):

Name 1:

Ownership 1:

Officeholder Title 1:

Name 2:

Ownership 2:

Officeholder Title 2:

Name 3:

Ownership 3:

Officeholder Title 3:

Company Registered Office Details

Company Registered Office

Note: The registered office is where all communications and notices to the company will be sent.

It is not necessarily the company’s head office or principal place of business. It can be at the company’s accountants or lawyers, or at one of the director’s home or office addresses. This is listed on the Certificate of Registration or Certificate of Incorporation.

Dealer Principal and Guarantor Details

Dealer Principal Full Legal Name 1

Residential Address 1

Mobile 1

Email 1

Dealer Principal Full Legal Name 2

Residential Address 2

Mobile 2

Email 2

Trading Premises Details

Proposed Nexus Pools Trading Name

Trading Premises Address

Trading Office Phone

Phone Number for Leads

Email for Leads

Trade License

List Type of License/s held

State of License

License Number

Business Background

Years in Business

Does the applicant currently have, or previously had, any type of agreement with or sell any other swimming pool manufacturer’s product(s)?

If Yes, please specify the manufacturer(s) and product(s)

Insolvency Proceedings

Have you, the company or any directors of the company entered into any form of insolvency or arrangement with creditors including bankruptcy, Part X, Voluntary Administration etc.?

If Yes, please provide details:

Has applicant (or any of applicant’s owners or predecessors if applicant is a business entity) ever filed for bankruptcy, reorganisation or any similar proceeding?

If Yes, please provide details:

Has your license ever been suspended or cancelled or have you been disqualified or banned from holding a builder or trade contractor license in any State?

If Yes, please provide details:

Have you, or if a company applicant any directors of the company been found guilty of a crime by a Court of Law?

If Yes, please provide details:

What is the geographical area that your business currently services?

Number of Employees:

Applicant Information

Name:

Office Holder Title (if signing on behalf of company):

Date

Acceptance

By ticking this box, I hereby certify that, to the best of my knowledge, the provided information is true and accurate.