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Credit Application

APPLICATION FOR A 30 DAY COMMERICAL CREDIT ACCOUNT

Company Details

Company Name*

ABN*

Address*

Type of Business

Years Trading

Postal Address

Contact Information

Contact Name*

Position Held in Company

Telephone Number*

Facsimle Number

Mobile Number

Email Address*

Please Provide 3 Trade References

Reference Name*

Reference Company Name*

Reference Telephone Number*

Reference Name*

Reference Company Name*

Reference Telephone Number*

Reference Name*

Reference Company Name*

Reference Telephone Number*

I/we supply the information contained in this form for the purpose of obtaining a commercial credit account with Elmich Australia Pty Ltd. I/we authorise Elmich Australia Pty Ltd to make enquiries regarding my/our credit worthiness. If the account is approved, I/we undertake to pay all amounts invoiced to me/us within 30 days of the close of the month in which the goods were supplied. If any amount invoiced is not paid within the agreed period, then all amounts invoiced to me/us by Elmich Australia Pty Ltd shall become due and payable immediately. All goods remain the property of Elmich Australia Pty Ltd until payment in full has been made.

Declaration

I declare the information provided above to be true and accurate to the best of my knowledge.

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