Credit Account Application

To Be Completed By Applicants - Please complete all sections and read the Terms and Conditions of Trade overleaf or attached.
DATE*
MM slash DD slash YYYY
REF NO.*
CLIENTS TRADE NAME*
CLIENT'S FULL or LEGAL NAME*
Phone*
Fax*
Mobile*
Account's Email*
Billing Address*
Purchasing Email*
State*
Postcode*
COMMERCIAL CLIENTS ONLY
ABN/ACN Number*
Requested Credit Limit*
Date Established*
MM slash DD slash YYYY
Contact 1*
Contact 2*
Position*
Position*
Phone*
Phone*
DETAILS OF OWNER (If Sole Trader) PARTNERS (If Partnership) OR DIRECTORS (If Company ) OR TRUSTEE (If a Trust)
Full Name*
Full Name*
Home Address*
Home Address*
Postcode*
Postcode*
Date of Birth*
MM slash DD slash YYYY
Date of Birth*
MM slash DD slash YYYY
Home Phone*
Home Phone*
TRADE REFERENCES
Business Name 1*
Business Name 2*
Address or A/C No*
Address or A/C No*
Phone*
Phone*
Email*
Email*
I Certify that the above information is true and correct and that I am authorized to make this application for credit. I have read and understand the TERMS AND CONDITIONS OF TRADE (overleaf or attached) of Accumax Global 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 there in. I agree that if I am a director/shareholder (owning at least 15% of the shares) of the client I shall be personally liable for the performance of the Client's obligations under this contract.
Signed (AG)*
Signed (CLIENT)*
Name*
Name*
Position*
Position*
WITNESS TO CLIENT'S SIGNATURE
Signed*
Name*
Date*
MM slash DD slash YYYY
ACCUMAX GLOBAL Pty Ltd - ABN 57 159 018 854
PO Box 1229 Canning Vale DC WA 6970 , Phone : 1300 222 862
www.accumaxglobal.com.au , Email : [email protected]
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Credit Account Application

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