Credit Account Application
To Be Completed By Applicants - Please complete all sections and read the Terms and Conditions of Trade on final page
Customer’s Details:
*
Individual
Sole Trader
Trust
Partnership
Company
Other:
Full or Legal Name
*
Trading Name (if different from previous):
Physical Address:
*
Suburb
*
State
*
Postcode
*
Billing Address
*
Suburb
*
State
*
Postcode
*
Email Address
*
Phone No
*
Personal/Business Details
Personal Details: (please complete if you are an Individual)
Driver’s Licence No
Business Details: (please complete if you are a Sole Trader, Trust, Partnership, Company or Other – as specified)
ABN
*
ACN
Date Established (current owners)
Nature of Business
*
Estimated Monthly Purchases: $
Credit Limit Required: $
*
Principal Place of Business is
*
Rented
Owned
Mortgaged
(to whom)
Directors / Owners / Trustee
(if more than two, please attach a separate sheet)
1. Full Name
*
Private Address
*
Suburb
*
State
*
Postcode
*
Driver’s Licence No
*
Phone No
*
Mobile Number
2. Full Name
Private Address
Suburb
State
Postcode
Driver’s Licence No
Phone No
Mobile Number
Account Details
Account Terms
*
30 Days (EOM)
COD
Accounts to be emailed?
*
Yes
No
Accounts Email Address
*
Accounts Contact:
*
Accounts Phone No
*
Trade References
(please provide companies that are willing to do trade references)
1. Name
*
Address
*
Email
*
2. Name
*
Address
*
Email
*
3. Name
Address
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 Tactile Systems Australia 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.
*
Customer Signature
*
Draw signature
|
Type signature
Clear
Name
*
Position
*
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