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AU Leisure Pools Dealer Application Form

Business Entity Name

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

Company Office Holder’s Details

Company Owner's Name and Officeholder Title (shareholders/members/partners):

Company Registered Office Details

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

Trading Premises Details

Trade License

Business Background

Insolvency Proceedings

Applicant Information

Single Checkbox Field