Ziptrak® Outdoor Blinds | Patented Track-Guided Patio Blinds

For a Free Estimate: Call 011 792-0253

Authorised Dealer Application Form

To become an authorised Ziptrak® dealer, please fill out the application form below and we will contact you soonest. (Minimum order required to qualify.)

NB. All fields are mandatory.

Name & Surname*

Please fill out this field.

Company*

Please fill out this field.

Company Registration*

Please fill out this field.

Location*

Please fill out this field.

Phone Number*

Invalid Input

Email Address*

Not a valid email address.

How long has the business been in existence?*

Invalid Input

Names of Directors or Business Partners*

Invalid Input

Name 3 Suppliers with contact details for references*

Please fill in this field. Some special characters like / (forward slash) are not allowed. If you have added disallowed characters, delete them and try again.

Name 3 Customers with contact details for references*

Please fill in this field. Some special characters like / (forward slash) are not allowed. If you have added disallowed characters, delete them and try again.

By submitting this form, I am authorising Ziptrak and their operators to process my personal information to answer my enquiry. Ziptrak will never share your personal information with any other party without your express permission.

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.