Membership Application Form Step 1 of 7 14% APPLICATION FOR DSA MEMBERSHIP Applicants for DSA Membership are assessed against criteria aimed at promoting industry professionalism and consumer protection. To commence the application process applicants are required to give the following information and provide transactional documentation as required to evidence compliance with the DSA Code of Practice. A non-refundable AUD$500 application fee should accompany this application. #ProudToBelong Please contact DSA should you have any queries. Email: askus@directselling.org.au Phone: 02 9159 1815 APPLICANT CONTACT DETAILS Person to be contacted about this application* First Name Last Name Title*Email* Direct Phone*(Please include country & area codes)APPLICANT ORGANISATION Organisation Name*Australian Business Number (ABN)*Please provide a short introduction of your company* Company LogoIs your company a member of another DSA or applying to be one in another Country?* Yes No If so, please list the countries you are a member of or applying to be one Registered Office* Address Line 1 City State / Province / Region Postal / Zip Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Business Address (if different to registered office) Address Line 1 City State / Province / Region Postal / Zip Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Postal Address (if different to registered office) Address Line 1 City State / Province / Region Postal / Zip Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Contact DetailsWebsite*Generic Email* Phone*(Please include country & area codes)Company DetailsCountry of Origin*Country of Ownership* Australia New Zealand U.S.A United Kingdom Other Other Country - Please specifyTrading as* Sole Trader Partnership Company Registered For GST* Yes No Please confirm the above information and proceed to the next sectionYesNo CONTACTS Chief Executive* First Name Last Name Title*Email* Assistant First Name Last Name Assistant’s Email Assistant’s Direct Phone(Please include country & area codes)(In keeping with the DSA Constitution, Member organisations must nominate a person to be the primary contact, to represent and bind the Member with the Association and receive all relevant communications)DSA Authorised Representative* First Name Last Name Title*Email* Direct Phone*(Please include country & area codes)Mobile(The Code requires Members designate a person to manage their complaint handling system and who will act as the point of contact with the Association in any related matters)Code Liaison Officer* First Name Last Name Title*Email* Direct Phone*(Please include country & area codes)Mobile(Name of the person responsible for the organisation's financial operation)Chief Financial Officer* First Name Last Name Title*Email* Direct Phone*(Please include country & area codes)MobilePlease confirm the above information and proceed to the next sectionYesNo DIRECT SELLING MODEL Business Model (Indicate if more than one)* Party Plan Hybrid Door to door Independent Sales Person (ISP) Agreement* Agency (Paid Commission) Distributor (Buy / Resell) Combination (Buy / Resell plus Commission for online sales) Is payment for products made directly to the?* Company Independent Sales Person Combination (ISP and direct to Company for online sales) Compensation Plan* Single Level Multi Level Start-Up Costs for ISP’s is in the form of* Consultant Sales Kit Training Fee Website Literature Sales Kit Cost AUD$*Sales Kit Retail Value AUD$*Training Fee Cost AUD$Website Cost AUD$Literature Cost AUD$Is there more than one price point for Start-Up?* No Yes If yes, please provide detailsIs a refund offered for return of Kit / Inventory? Yes No If yes, please provide detailsIs a refund offered for unused literature?*YesNoIf yes, please provide detailsNumber of ISP’s (in Aust.)*Sales at retail value (in Aust.) for previous 12 month period?* AUD$0 – $500K AUD$501K – $1.0M AUD$1.0M – $1.5M AUD$1.5M –$2.0M AUD$2.0M – $2.5M AUD$2.5M –$3.0M Other Other please advisePlease confirm the above information and proceed to the next sectionYesNo PRODUCT DETAILSProduct Categories* Aromatherapy Cleaning Products Clothing & Accessories Cosmetics Food Products Health & Wellness Household & Decor Jewellery Kitchenware Learning Products, Toys & Stationery Nutritional Drinks & Supplements Scrapbooking & Crafts Services Skincare, Personal Care & Fragrances Other Other – Please DescribeBrand Name(s) & Product Description Australian Register of Therapeutic Goods – Are your products* Listed Awaiting Approval Does Not Apply If applicable, what are the listed products with TGA and their ARTG number? If applicable, what are the products that are in process of obtaining TGA approval? Are your products also sold through Retail Outlets Online Autoship Direct Marketing Wholesale Markets/Fairs Pop Up Kiosks Do you have a Written Guarantee* Yes No Do you have an Unconditional Guarantee* Yes No Customer Guarantee* 30 Days 60 Days 3 Months 6 Months One Year More Comments Please confirm the above information and proceed to the next sectionYesNo DOCUMENTATION A copy of each of the below listed documents is required to consider your application. Please indicate below which of the documents are currently available. Documents can be submitted as an attachment to this form, by email to askus@directselling.org.au or mail to DSA, Level 16/175 Pitt Street, Sydney NSW 2000 Australia . Point of Sale Transactional Documentation Customer Order Form Customer Invoice Customer Order FormCustomer InvoiceCustomer GuaranteeCurrent Version of Your Distributor/Consultant Agreement Manual / Policies & Procedures Privacy Policy (If applicable) Distributor/Consultant AgreementManual / Policies & ProceduresManual / Policies & ProceduresFull Details of Your Compensation Plan Starter Kit Compensation PlanPrivacy PolicyAre these documents currently in final form?YesNoIs Your Financial Advice Provided* In House By an Independent Professional Name* First Name Last Name Organisation (if by an Independent Professional)Email Phone(Please include country & area code)MobileIs Your Legal Advice Provided* In House By an Independent Professional Name* First Name Last Name Organisation (if by an Independent Professional)Email Phone(Please include country & area code)MobilePlease confirm the above information and proceed to the next sectionYesNo DECLARATION*I am the CEO and authorised to make this declaration To the best of my knowledge and belief the Applicant’s business operations including the use of point of sale and marketing documentation complies with relevant law. The Applicant agrees as a condition of Membership to comply with the Association’s Constitution. The Applicant agrees as a condition of Membership to comply with the Association’s Code of Practice. The Applicant agrees as a condition of Membership to promptly inform the Association of any change in its circumstances, including material changes to its point of sale and marketing documentation, its authorised representative and/or designated person responsible for administering the complaint handling system. AUTHORISATION*If you are intending to submit an application for membership with Direct Selling Association New Zealand (DSANZ), please tick the box below authorising DSA to share the due diligence with DSANZ. This will streamline your application process. If this is not applicable to you, please disregard. Yes, I give permission to DSA to share due diligence with DSANZ Full Name* First Name Last Name Date PROCESSING FEE A non-refundable processing fee of AUD$250.00 is payable with this application.Payment Gateway Preferred*Paypal / Credit CardEFTMake your payment directly into our bank account. Account Name: Direct Selling Australia Institution: Commonwealth Bank, Martin Place Sydney NSW 2000 AUSTRALIA BSB: 062 575 Account No: 1025 5269 Swift Code: CTBAAU2S Price: $ 500.00 Please use your Company Name as the payment reference. You will be notified when the funds have cleared in our account.Non-refundable Application Processing Fee* Price: $ 500.00 EmailThis field is for validation purposes and should be left unchanged.
