Humphreys Office Supplies Application Form

							                                                                            52 Balgowlah Road Balgowlah
                                                                            Phone: 9951 0000
                                                                            Fax: 9951 0099
                                                                            Email: direct@humphreys.com.au

                                                                            www.humphreysoffice.com.au
                         ABN: 13 125 920 372

                                 APPLICATION FOR CREDIT ACCOUNT
Registered Name:                                               Trading Name:

ACN:                                                           ABN:

Type of Business:                                              No of Employees:

                                                               Mailing Address (if
Delivery Address:                                              different to
                                                               delivery address)



Estimated Monthly Expenditure: $..........................

Purchase Contact:                                              Accounts Contact:

Telephone:                                                     Telephone:

Fax:                                                           Fax:

Email:                                                         Email:




Name of Principals – please list the full name and address of the owner, or partners or directors of the applicant




Trade References

Company:                                  Contact:                                   Tel:

Company:                                  Contact:                                   Tel:




Authorised Users of Account

Name:                                                          Password:

Name:                                                          Password:
Terms & Conditions

      Registered Businesses only may apply

      All accounts must be paid in full by the 20th of the following month and failure to pay by the due
       date may result in us using our debt collection agency to retrieve payment.

      Humphreys Office Supplies is a member of the Australian Creditors Association. As such we are
       obliged to manage our accounts in a professional manner and reserve the right to invoke a
       reasonable collection charge on overdue accounts.

      A credit reference check will be done on the business and references will be contacted.



I/We the undersigned on behalf of the applicant have read and agreed to the terms and
conditions contained on this form.

       Signature                      Full Name                      Position                 Date