Miro - Distributor Registration

Become a Distributor

If your company is involved in Telecommunications, such as a Wireless ISP (WISP), Internet Telephony Service Provider (ITSP) or Internet Service Provider (ISP) or the IT Industry, be it Retail, Support, Installations, Supply or Distribution, you can now offer your clients the benefits of the latest telecommunication technology.

Miro distribution specialise in the latest Wired & Wireless networking, VoIP and IP Video technology! We are distributors for the leading vendors in these industries. Simply register as a Miro distributor to qualify for our very competitive trade prices.

You can now fill out our Distributor application online or alternatively you can download the printable PDF version to fill out and fax to us on 012-6570944

Once your application has been approved, we will provide you with trade prices and details of the order / delivery procedures.

PLEASE TAKE NOTE OF THE FOLLOWING:

Payment methods accepted by Miro distribution:

Cash
EFT
Terms as per your individual account

Online Distributor Application Form

Registered Name of Business:

Trade Name of Business:

Company Registration Number:

VAT Registration Number:

Nature of Business:

Type of Business:

Directors/Members/Owners
(Full name ,ID, Physical Address):

Physical Address:

Please supply the following relevant contact details

Buyer Name:

Buyer Tel:

Buyer Email:

Technical Name:

Technical Tel:

Technical Email:

Accounts Name:

Accounts Tel:

Accounts Email:

Office Tel. Number:

Office Fax. Number:

Primary Mobile Number:

Primary Email Address:

Website URL:

Which other trade suppliers are you registered with?

Person applying for the account name:

Sales person spoken to:

Where did you hear about us?

Please Specify the publication/website/referrel/show or other:

By submitting this form I hereby confirm that:

1. The information contained in this form is true and correct,
2. I am duly authorised to enter into agreements for/on behalf of the applicant,
3. I have read and understood the Miro distribution terms and conditions and accept them as binding upon the applicant,
4. I understand that this is a distributor registration only and not a credit application.

I have read and accept the terms and conditions

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