OPAC Export Form

Company(Required)

Address(Required)

Street Address City State / Province / Region ZIP / Postal Code

Country

Your Company's Website

Name(Required)

First Last

Primary Job Title(Required)

Email(Required)

Phone(Required)

FAX(Required)

Do you have more than one office?(Required)

Please select the option that best describes your company(Required)

Company Structure Information

If not publicly held, please provide the name and address of each owner of at least 10% of company shares and his/her ownership percent.(Required)

Provide the name and address of affiliated and commonly owned companies. Indicate which, if any, of these affiliated and commonly owned companies account for more than 25% of the parent company’s sales or purchases during the last fiscal year.(Required)

Please provide the destination countries products if known.(Required)

CAPTCHA

Your information and data (Personal Information) is collected by Seeley International and will be used and held in accordance with our Privacy Policy . Your Personal Information will be used by us for the purpose of: providing our goods and services to you (including the Seeley International website), assisting us to process and respond to any queries you submit, honouring product warranty claims, and for related administrative purposes. It may also be disclosed to our related entities and third-party suppliers and service providers (including those based overseas) for those purposes. By submitting this form, you consent to the following

1. Our use of your Personal Information for those purposes, in accordance with our Privacy Policy;

2. Our use of cookies; and

3. Receiving direct marketing content from us and our suppliers about our products and services via email.

You may withdraw your consent to our use of your Personal Information or cookies at any time by closing your account, or by ceasing to use our website. If you do not provide your Personal Information to us or do not consent to our use of cookies, we may not be able to provide you with our goods or services (including use of our website) or respond to your queries. If you do not want to receive direct marketing content from us please deselect I want to receive promotions and offers from Seeley.

You also confirm that you have read and accept our Terms and Conditions, and acknowledge that you are at least 16 years of age.

OPAC Export Form

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