Credit Account Application

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Credit Account Application

Please complete all sections and refer to the Terms and Conditions of Trade.
Customer's Details
Customer Type*
- Individual
- Sole Trader
- Trust
- Partnership
- Company
Full or Legal Name
First Last
Trading Name (If different from above)
Physical Address*
Street Address Address Line 2 Town / Suburb State Postcode
Is your billing address different to your physical address?
- Yes
Billing Address*
Street Address Address Line 2 Town / Suburb State Postcode
Email*
Phone Number*
Mobile Number
Fax Number
Personal Details
Date of Birth*
DD slash MM slash YYYY
Drivers Licence Number*
Business Details
ABN*
ACN*
Date Established (Current Owners)*
DD slash MM slash YYYY
Nature of Business*
Paid Up Capital*
Estimated Monthly Purchases*
Credit Limit Required*
Principle Place of Business is*
- Rented
- Owned
- Mortgaged
Mortgaged to whom*
Directors / Owners / Trustee*
Full Name DOB Private Address Drivers Licence No Phone No. Mobile No.
Account Terms
Account Terms*
- 30 Days
- COD
Purchase Order Required?
- Yes
- No
Accounts to be Emailed?
- Yes
- No
Accounts Contact*
Accounts Email*
Phone Number*
Bank*
Branch*
Account Number*
Trade References
Please provide companies that are willing to do trade references.
Trade Reference 1*
Name Address Phone Email
Trade Reference 2*
Name Address Phone Email
Trade Reference 3*
Name Address Phone Email
I certify that the above information is true and correct and that I am authorised to make this application for credit. I have read and understand the TERMS AND CONDITIONS OF TRADE of T & S Refrigeration & Electrical Pty Ltd which form part of, and are intended to be read in conjunction with this Credit Account Application and agree to be bound by these conditions. I authorise the use of my personal information as detailed in the Privacy Act clause therein. I agree that if I am a director/shareholder (owning at least 15% of the shares) of the Customer I shall be personally liable for the performance of the Customer's obligations under this contract.
Signature*
Name*
First Last
Position*
Office Use Only

08 8522 6752

08 8522 6752

Customer's Details

Personal Details

Business Details

Account Terms

Trade References

Office Use Only

Full Name	DOB	Private Address	Drivers Licence No	Phone No.	Mobile No.