Credit Application

Customer Details

Name

Trading as

Type of Business

Website Address

If a Company ACN

ABN

Address

Postal Address

Contact for Accounts Payable

Accounts e-mail address

Contact for Procurement

Procurement's email address

Estimated Monthly Purchases

Preferred Sales Person at Primehyd

Directors

Director 1 Surname

Director 1 Christian Names

Director 1 Residential Address

Director 1 Date of Birth

Director 1 Telephone

Director 2 Surname

Director 2 Christian Names

Director 2 Residential Address

Director 2 Date of Birth

Director 2 Telephone

Company Details

Name of trustee

Name of trust

Date of trustee’s appointment

Date of creation of trust

Are business premises leased?

If Yes, landlord's name

Telephone

Property Holdings: Attach a list of the properties owned by Directors/Company to sure Customers A/c.

Trade References: (Companies with whom the Customer is currently trading – No Banks, Fuel or associated companies.)

Company 1

Company 1 Phone

Company 2

Company 2 Phone

Accounting Details

Do you always quote order numbers?

Name of Accountant

Accountant's Phone

In the case of a Company please state: What is the Authorised Capital $

Paid up Capital $

Annual Sales $

No. of Employees

No. of sub-contractors

Bank Name

Branch

Security for the Bank Overdraft is

Signature 1

Witness 1

Signature 2

Witness 2

For and on behalf of

As trustee for the

Dated

Guarantor 1 Full Name

Guarantor 1 Address

Guarantor 1 Signature

Guarantor 1 Witness

Guarantor 2 Full Name

Guarantor 2 Address

Guarantor 2 Signature

Guarantor 2 Witness

By signing this document I confirm that I have read, understand and agree to the terms and conditions of trade. *

Full Name of Applicant

Date

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