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
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