Introduction Form

Please complete all fields below, for any questions, contact Melanie Hart

1/ All introductions are made in acknowledgement of the Introducer Terms and Conditions of the referrer agreement.

2/ All introductions must be made by completion of this form otherwise they may not be accepted.

3/ Upon submission of the introduction form – a Supply Clusters representative will review the submission and allocate it to the introducer if the Introducer is not already in the system or the organisation is not currently trading or engaged with Supply Clusters

4/ All enquiries for referrers should be made to your designated contact as specified in the Introducer Terms and Conditions or as otherwise communicated to you.

5/ Payments for referrals will be made in the month after the referred member has paid their first year of membership and agreed to the membership terms and conditions.

    Introducer Details

    Company Details

    Lead Details