Synergy

Equipment retailer application form

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Ready to become a registered equipment retailer with Synergy? Complete the form below.

Registered Company Name

Trading Name / Brand

Australian Business Number (ABN - 11 digit unique business identification number)

Company address (Australian business address linked to the ABN)

Company phone number

Name of primary contact

Primary contact phone number

Primary contact email address

Name of representative

Representative's role title

Representative's email address

Representative's phone number

I agree that I have read, understood and confirm that I am authorised to accept the DER Equipment Retailer Terms

I agree that I have read and understand the Privacy Policy and Collection of Information Statement

Synergy acknowledges the Traditional Custodians throughout Western Australia and their continuing connection to the land, water and community. We pay our respects to all members of the Aboriginal communities and their cultures; and to Elders past, present and emerging.

Synergy

Equipment retailer application form

Apply now

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Equipment retailer application form

Apply now