e&s Commercial Industry Associate (Personal Use) Purchase Request Form

e&s Commercial Industry Associate (Personal Use) Purchase Request Form

As a valued member of the construction industry, we would like to offer you Industry Associate (Personal Use) Pricing on purchases for your personal use. Please fill in this form with accurate information and a member of our Commercial Team will be in contact as soon as possible. NB: this is not to be used for standard business or office use purchases.
CONTACT INFORMATION
Your e&s Staff Member Contact Name
Your Name

First NameLast Name
Your Company Name
Your Position in Your Company
Your Work Email
Your Phone Number
Please enter a valid phone number.Format: 0000000000.
Your Address

Street Address

CityState / Terrority

Postal CodeCountry
Your Reason For Purchase
Family/Friends Name

First NameLast Name
Family/ Friends Address

Street Address

CityState / Terrority

Postal Code
Family/Friends Email
Family/Friends Phone Number
Please enter a valid phone number.Format: 0000000000.
PRODUCT SELECTION REQUIREMENTS
Product Selection Requirements (select the most relevant option)

OPTION A: Products To Quote List

OPTION B: File Upload - supporting documentation

Please upload any files that will be of assistance
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OPTION C: Custom Selection Appointment (Preferred Showroom Location)
PICK UP or DELIVERY INFORMATION
Is delivery of the goods required?
Is removal of old product(s) required?
Is installation of new product(s) required?
Are the goods to be installed at the above address?
Installation Address

Street Address

Street Address Line 2

CityState / Terrority

Postal CodeCountry
Are there any stairs or accessibility issues at the delivery address?
Approx Delivery Date or Pick Up Date Required

DayMonthYear
Additional Important Information:
Type to enter information
Pricing Subject To Approval

Please note that when you hit submit your request will be received by a member of our Commercial Team for review and pricing will be subject to managers approval and your signature confirms you acknowledge all information provided is correct. NB: Proforma/Agency Brands including Miele, Gaggenau, Neff, Asko will require their own Industry Associate Form to be completed.
Collection of Personal Information*
*Please tick "yes" to confirm you have read the following privacy collection notice: the information collected from you today will be provided to e&s for the purpose of contacting you regarding your product requirements, and your data will be handled in accordance with the e&s privacy policy available at www.eands.com.au/privacy-policy.
Signature
Should be Empty:

CONTACT INFORMATION