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30 Days Credit

PARTICULARS OF APPLICANT

Company Name * :
ABN * :
Trading or Business Name * :
Telephone * :
Contact:
E-mail * :
Fax:
Business Address * :
Postal Address:
Registered Address * :
Nature of Business * :
Year Established * :
Is your company a trustee of a Trust? * Yes No
Trust Name * :
Is the Trustee entitled to be indemnified out of the assets of the Trust? * Yes No

PARTICULARS OF DIRECTORS

1) Full Name * :
Phone * :
Position Held * :
Address * :
Do they have authority to use this account? * Yes No
2) Full Name:
Phone
Position Held:
Address:
Do they have authority to use this account? Yes No
3) Full Name:
Phone
Position Held:
Address:
Do they have authority to use this account? Yes No
4) Full Name:
Phone
Position Held:
Address:
Do they have authority to use this account? Yes No

PARTICULARS OF ASSETS OWNED BY YOUR BUSINESS

Only 1 per line(Mention Mortgage if applicable) *

TRADE REFERENCES

1) Full Name * :
Address * :
Phone * :
Fax
2) Full Name * :
Address * :
Phone * :
Fax
3) Full Name * :
Address *
Phone * :
Fax

ESTIMATED MONTHLY PURCHASES:

DETAILS OF PRESENT CREDITORS (Including Mortgages) Amount Owed

Only 1 per line(Mention Mortgage if applicable)
BANK NAME * :
BRANCH * :
ACCOUNT NUMBER * :
Does the Applicant currently hold Builders Indemnity Insurance? * Yes No
If so whome?:
Number of Dwellings * :
You agree to be bound by the Terms and Conditions of trade attached *