CREDIT ACCOUNT APPLICATION

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CREDIT ACCOUNT APPLICATION Powered By Docstoc
					                                                                                      P.O. Box 6006
                                                                                      33 Lockwood Road
Rodney Senior Pty Ltd A.B.N. 69 074 108 142                                           Shepparton 3632

                                                                                             Telephone 03 58315411
                                                                                                   Fax 03 58312876
                                                                                   email: rodney@seniorsteel.com.au
                                                                                             www.seniorsteel.com.au

                                       CREDIT ACCOUNT APPLICATION

NAME OF APPLICANT:______________________________________________________________________________

TRADING NAME:____________________________________________________________________________________

BUSINESS ADDRESS:________________________________________________________________________________

POSTAL ADDRESS:__________________________________________________________________________________

TELEPHONE NUMBER:_____________________         FACSMILE NUMBER:______________________________

MOBILE PHONE NUMBER:_______________________________________EMAIL ADDRESS:



IF A COMPANY

REGISTERED NAME: ______________________________________________YEARS INCORPORATED:______________________

A.C.N. NUMBER:______________________________           A.B.N. NUMBER: ______________________________

E-MAIL ADDRESS: ____________________________________________   NOMINAL CAPITAL:___________________________

PAID UP CAPITAL:______________________

NAME AND ADDRESS OF BANK:_________________________________________________________________________________

ANTICIPATED MONTHLY PURCHASES:________________________ CREDIT LIMIT REQUEST ___________________________

PERSON TO CONTACT FOR ACCOUNT PAYABLE:_______________________________________________________________

PURCHASING MANAGER __________________________________________________________

DIRECTORS

NAME:_________________________________________________________________________________________

ADDRESS:______________________________________________________________________________________

NAME:_________________________________________________________________________________________

ADDRESS:_____________________________________________________________


In consideration of agreement by Rodney Senior Pty Ltd to supply goods on credit
to______________________________________(Insert Company Name) hereinafter referred to as (“The
Company”) we hereby jointly guarantee payment by (“The Company”) of all indebtedness for such goods.
This agreement shall be a binding and continuing guarantee. (Must be signed if a credit limit of more than
$5,000 is required).
DATED THIS_________________________DAY OF_______________________________________20_______

GUARANTOR__________________________________           WITNESS___________________________________

PRINT FULL NAME____________________________           PRINT FULL NAME__________________________

GUARANTOR__________________________________           WITNESS___________________________________

PRINT FULL NAME____________________________          PRINT FULL NAME__________________________


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IF REGISTERED NAME, SOLE TRADER OR PARTNERSHIP – FULL DETAILS OF PARTNERS:

BUSINESS NAME REGISTRATION NUMBER:_______________________________________________________________________

ADDRESS:______________________________________________________________________________________________________

________________________________________________________________________________________________________________

NAME: ________________________________________________________________________________________________________

ADDRESS:______________________________________________________________________________________________________

________________________________________________________________________________________________________________

D.O.B:________________________ LICENCE NUMBER:______________________________________________________________

NAME AND ADDRESS OF BANK:__________________________________________________________________________________

ANTICIPATED MONTHLY PURCHASES:_____________________ CREDIT LIMIT REQUEST _______________________________

PERSON TO CONTACT FOR ACCOUNTS PAYABLE:______________________________________________________________

PURCHASING MANAGER:______________________________________________________________________________________



STATEMENT BY APPLICANT(S) FOR CREDIT

1. Access to Consumer Credit Information for a Commercial Application (Section 18K(1)(b) Privacy Act 1988).
I /We agree that Rodney Senior Pty Ltd may seek from a credit reporting agency, a credit report containing personal information about
me/us to assess whether to accept me/us for the purpose of assessing my/our application for Credit. Or whether to accept me/us a guarantor
for, or provided to, the borrower (named below).

2. Exchanging information with other Credit Providers (Section 18N(1)(b) Privacy Act 1988). I /We agree that Rodney Senior Pty Ltd
may seek from other Credit Providers personal information about me/us for the purpose of assessing my/our application for Credit.

SIGNATURE: _________________________________SIGNATURE:_________________________________________

TRADE REFERENCES
I _____________________________________________of_________________________________(insert company name)

Hereby authorise Rodney Senior Pty Ltd to obtain trade references from the following –

1.___________________________________________Telephone________________________Facsimile________________

2.___________________________________________Telephone________________________Facsimile________________

3.___________________________________________Telephone________________________Facsimile________________

I /We hereby declare that all details provided here on are true and correct.

I / We understand that your terms of payment are strictly 30 days nett, and agree to pay in accordance with these terms if credit is granted.

SIGNATURE:_______________________________________________________________________

OFFICE USE ONLY

AUTHORISED           DATE      _______________                RODNEY SENIOR                  ______________________________




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