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Business Details
Credit Information
Business owners
References
Address Details
ABN Number
Company Name
Trading Name(s)
Business Structure
Sole Trader
Partnership
Company
Trust
Govt. Dept
Other
Business History
Have any of the business owners ever been declared bankrupt?
Yes
No
Have any of your business owners been involved in businesses that have failed or been liquidated?
Yes
No
If Yes, please provide the details
Bank Details
Bank name and branch
Is the Business Registered for GST?
Yes
No
Business premises
Owned
Leased
Parent Company
Monthly Credit Limit($)
Accounts Contact Details
Accounts Payable Contact
Accounts Payable Phone
Accounts Payable Email
Email for weekly invoicing
Preferred payment method
EFT
Credit Card
Cheque
Please include the details below for each director, partner, trustee, etc. of the business
Owner 1
Full Name
Contact Number
Street Address
Owner 2
Full Name
Contact Number
Street Address
Owner 3
Full Name
Contact Number
Street Address
Trade Reference 1
Name
Nature of business
Contact Name
Phone
Trade Reference 2
Name
Nature of business
Contact Name
Phone
Trade Reference 3
Name
Nature of business
Contact Name
Phone
Billing Address
Address Line 1
Address Line 2
City
Country
Australia
State
Postal Code
Phone Number
Delivery Address
Address Line 1
Address Line 2
City
Country
Australia
State
Postal Code
Phone Number
Authorized Signatures (Director/Partner/Proprietor/Trustee)
First Name
Last Name
Position
Gender
Male
Female
Email
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