CREDIT ACCOUNT APPLICATION AND AGREEMENTCredit Account Application and Agreement • May 26th, 2011
Contract Type FiledMay 26th, 2011ACCOUNT TYPE (delete not applicable) Individual Sole Trader Partnership Trust APPLICANT(S) DETAILS: For Joint or Partnership accounts, details of all applicants must be provided. Use separate page if necessary. Full Name Residential Address Postal Address Date of Birth(please attach a form of ID) Contact Details Private Phone No. Mobile No. Business Phone No. Fax No. Email Address: Employer Nature of Business (Main Activity) Anticipated Value Monthly Purchase $ Maximum Credit requested $ Order Number required for purchases No Yes If yes state format. Contact Person for Payment of Account Email Address Have proceedings for bankruptcy, insolvency or recovery of debt ever been brought against you? No Yes If yes provide details: ………………………………………………………………………………………………………………………………………………………………………………………………………………………………………… Bankers Solicitors Accountant