Credit Account Application

To Be Completed By Applicants – Please complete all sections and read the Terms and Conditions of Trade overleaf.

Customer's Trade Name*
Customer's Full or Legal Name*
- Phone*
- Mobile
- Billing Address*
  Address City State Postcode Country
- Fax
- General Email*
- Physical Address
  Address City State Postcode Country
COMMERCIAL CUSTOMERS ONLY
- ABN/ACN Number
- Requested Credit Limit
- Primary Contact
- Position
- Phone
- Email
- Date Established
  Date Format: MM slash DD slash YYYY
- Accounts Contact
- Position
- Phone
- Email
DETAILS OF OWNER
(If Sole Trader) PARTNERS (If Partnership) OR DIRECTORS (if Company) OR TRUSTEE (If a Trust)
- Full Name
- Home Address
  Address City State Postcode Country
- Home Phone
- Full Name
- Home Address
  Address City State Postcode Country
- Home Phone
TRADE REFERENCES
- Business Name 1
- Address or A/C No
- Phone
- Fax
- Business Name 1
- Address or A/C No
- Phone
- Fax
*
- 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 (overleaf or attached) of Associated Express Couriers 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. I agree that if I am a director/shareholder (owning at least 15% of the shares) of the Customer I shall be personally liable for the performance of the Customer’s obligations under this contract.

COMMERCIAL CUSTOMERS ONLY