CREDIT APPLICATION

I/We hereby make application for the opening of a 14 day credit account and provide the following information in support there of: (This information will be treated as strictly confidential)

Full trading name:
Incorporated in:

ABN:
Address of registered office:
Business Address:
Postal Address:
Telephone No:
Fax No:
Type of Business:
Date Commenced:	(**If under one year name and address of ex-employer or previous business)
Are premises leased/owned?

Principle Owners and/or Directors:

Surname
Christian Name/s
Residential Address

Anticipated weekly purchases: $
Credit requested: $
Trade references
1) Name:
1) Phone:
2) Name:
2) Phone:
3) Name:
3) Phone:
Name of Bank:
Branch:

I/We confirm that the information contained in this application is correct and that no other party or entity has any financial interest in the business named.

I/We do hereby warrant that no threat or state of bankruptcy or insolvency exists.

Name:

Date:

Submit

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