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Credit Application
Payment Terms - Net seven (7) days from date of invoice.
Details of Applicant
Registered Legal Name
ACN
ABN
Business Trading Name
Registered Office
Street Address
City / Town / Suburb
State
Postcode
Telephone
Fax
Email
Site Address
Street Address
City / Town / Suburb
State
Postcode
Work Cover Industry Code
Work Cover Industry Name
If registered Proprietary Limited Co. Excludes Listed Public Company Directors.
Directors Name & Address
Name
Address
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If Partnership or Sole Trader Principals Names & Addresses
Name
Address
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Date Commenced Business
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Year
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Estimated Monthly Purchases
Bankers
BSB
Type of Business
Accounts Payable Contact Name
Accounts Payable Telephone
Accounts Payable Fax
Accounts Payable Email
Please include telephone number and fax numbers.
Trade References
Name
Telephone
Fax
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Consent
(Required)
By submitting this form, I agree to the
privacy policy
conditions.
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