CommentsThis field is for validation purposes and should be left unchanged.Reseller DetailsDigital Marketing Consultant Name (if known):*Please enter the name of your contact at LocaliQ.Reseller Name:*Please enter your business name here as it is listed on the ABN/NZBN.Reseller Location:* Australia New Zealand Reseller ABN*Reseller NZBN*Reseller Address:*No PO Boxes please. Street Address Address Line 2 City State Postcode Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Reseller Email Address:* Commencement Date: DD slash MM slash YYYY Marketing Services:*Please select which of LocaliQ's services you will be reselling. Please note that LocaliQ may authorise (in writing) the Reseller to sell additional Marketing Services in future at Commission Rates agreed in writing between LocaliQ and the Reseller. Search SEO CCLE Display Social Site TotalLiveChat TotalTrack YouTube Display Creative Service Video Creative Service Custom Facebook Campaign Invoicing, Payment & Commissions Invoicing & Payment Terms (a) Subject to paragraph (b), all Marketing Services Fees for Marketing Services supplied under this Agreement are payable by the Reseller in advance of each Cycle of Marketing Services supplied by LocaliQ. (b) If the total Marketing Services Fees payable by Reseller for one month exceeds $25,000, then LocaliQ (in its absolute discretion) may offer credit terms to the Reseller to the effect that the Marketing Services Fees for Marketing Services are invoiced monthly in arrears and payment is due 28 days from the invoice date. Commission % Rate (% of Net Collected Revenue)* Below $10,000 | 8.0% $10,001 - $20,000 | 9.0% $20,001 - $50,000 | 10.0% $50,001 - $100,000 | 11.0% $100,001 - $150,000 | 12.0% $150,001 - $250,000 | 13.0% $250,001 - $499,999 | 14.0% $500k and above | 15.0% *based on LocaliQ's standard publisher spendLocaliQ reserves the right to amend and change the Commission % Rate and Commission Tiers in the table, without 3rd party approval, provided 30 days notice is provided of any such change. ConfirmationAuthorised Representative Name:*Please enter the name of someone who is authorised to sign this form.Authorised Representative Position:*Please enter the position of the authorised representative.Terms & Conditions Confirmation (AU):*By checking the box below, you confirm that you have read the terms and conditions listed here and agree to all terms and conditions mentioned. Confirm Terms & Conditions Confirmation (NZ):*By checking the box below, you confirm that you have read the terms and conditions listed here and agree to all terms and conditions mentioned. Confirm Signature*Effective Date:* DD slash MM slash YYYY
