APPLICATION FOR BUYER LIMIT by hjkuiw354

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									                                AMERICAN HOME ASSURANCE COMPANY
                                                ABN 67 007 483 267
                                    Incorporated with Limited Liability in the USA
                                    A Member of American International Group Inc.
                                   APPLICATION FOR BUYER LIMIT
Please note that a signed and fully completed original application must be sent to AHAC with attaching
                                   documents before an endorsement can be issued.

Insured:                                      Policy Number:                                Date:



          Buyer name:          ________________________________________________________
          Address:             ________________________________________________________
                               ________________________________________________________
          ACN:                 ________________________________________________________


Credit Limit Required:

General description of Buyer's business:




Please provide the following details of the Buyer's major suppliers:

Supplier Name                           Address                                      Telephone Number




Does the Applicant sell to related companies? If so, please provide details:
Name(s):
Group Structure:
Group credit limit required:

Please attach minimum 2 years financial information and an up to date Mercantile Report on the Buyer.

Applicant's Experience with Buyer

Number of years selling to Buyer:

Please provide sales and high credit with Buyer over past 2 years and a projection for the next 12 months:

                                  Next 12 months                19____                    19____
           Sales:                 ___________                   __________                _________
           High Credit:           ___________                   __________                _________

Describe Terms of Payment:




Please describe Buyer's general payment pattern:

f/credit/buyerapp94
Ageing of Receivables from Buyer:

If Applicant presently has receivables outstanding from this Buyer and/or any company related to this Buyer,
please provide a current ageing of receivables:

          Current         30 Days           60 Days             90 Days            120 Days
          ________        ________          ________            ________           ________

Please provide an explanation for overdue amounts:




Please provide details if the Applicant has ever extended or rescheduled a due date or changed the terms of
payment after shipment to this Buyer, or put this Buyer in a payment plan.




Does the Applicant have any knowledge of default, rescheduling or debt re-negotiated by the Buyer with
relation to obligations due to other suppliers?      Yes            No
If yes please provide details:




Does the Applicant have or plan to obtain any form of security on the Buyer (liens, escrow accounts, stand-
by Letter of Credit, personal guarantees of owners etc.) Yes           No
If yes please provide details:




Additional Information

Please provide any other information that may support this application:




The Applicant warrants by the signing of this application by an authorised officer that, to the best of its
knowledge, the statements set forth herein are true and that no material information has been withheld, and
that it will not disclose to third parties or to the Buyer any discussions or correspondence relating to this
application nor the existence of any policy which may be issued except in confidence to its insurance broker
or bank.

Signed:
Name (Print)                                               Title:
Corporation:
Date:                                                      Telephone:

								
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