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ANZ Business One Visa Credit Card Application (PDF)

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					ANZ Business One Visa Credit Card Application



1. ACCOUNT DETAILS

Please tick ✔ which card you wish to apply for:
    ANZ Business One – Rewards               ANZ Business One – Cash Rewards         ANZ Business One – Interest Free Days           ANZ Business One – Low Rate

Account credit limit                   Nominated branch for collection of cards                 Business name to appear on all cards (max. 19 characters inc. spaces)
$


Design My Card Image No. (as per confirmation e-mail)


The image will be applied to all cards issued on the account.

2. BUSINESS DETAILS

Registered business name                                                             Business trading address (not PO Box)



Business name (if di erent from the registered business name)
                                                                                     Suburb                                State                Postcode
                                                                                     Business postal address (if di erent to business trading address)

ABN/ACN

Type of industry                                                                     Suburb                                State                Postcode
Type of Business entity (e.g. sole trader, partnership, company,trust etc)           Business contact number                           Fax number



3. BUSINESS QUESTIONS

Number of directors/partners/proprietors                                             Other borrowing facilities
                                                                                     Please supply details of current borrowing facilities held at institutions
Number of employees
                                                                                     including ANZ (e.g. business overdraft, loans, nance lease, hire
How long have you worked in this industry? months                       years        purchases etc.).

How long has the business been operating for?                                        1. Type of facility                       Institution

Number of years with current bank
Does this business have existing accounts with ANZ?                   Yes       No     Purpose                                 Current limit

Is this business a franchise?                                         Yes       No
Has your line of business changed over the past ve years? Yes                   No   2. Type of facility                       Institution
Does this business own property other than
that from which it operates?                                          Yes       No
                                                                                       Purpose                                 Current limit
Accountant’s name



Accountant’s phone number                                                            3. Type of facility                       Institution


                                                                                       Purpose                                 Current limit
Accountant’s fax number


                                                                                     4. Type of facility                       Institution


                                                                                       Purpose                                 Current limit




Australia and New Zealand Banking Group Limited (ANZ) ABN 11 005 357 522.                                                                                    Page 1 of 4
ANZ Business One Visa Credit Card Application



4. DIRECTOR DETAILS DIRECTOR 1

Title                  Given name/s                                                             Home address

Surname
Date of birth                         Aust.Driver’s licence number
                                                                                                Suburb                                     State                   Postcode
                                                                                                Previous address (if at current address less than 3 years)
Are you an existing ANZ customer?                                           Yes      No

Number of dependants                                                                            Suburb                                     State                   Postcode
Marital Status                                       Single    Defacto         Married
                                                                                                Contact number (mobile preferred)
Card Details
Card Required?                Yes       No
Monthly Spend Cap             Unlimited         Preferred amount           $
Please nominate your monthly spend cap (card limit) as ‘unlimited’ or a preferred amount.
’unlimited’ allows the cardholder full access to available account credit.

Cardholder name as you wish it to appear on card (max. 19 characters inc. spaces)


Security Code^
^ For verbal identi cation purposes eg. a word meaningful only to you.

Personal Finances
Income                                                                                         Expenditure
                                                 $                                per month                                                     $                               per month
Salary/wages (gross)                                                                           Home loan repayments
                                                 $                                per month                                                     $                               per month
Rent received                                                                                  Other loan repayments
                                                 $                                per month                                                     $                               per month
Other (please specify)                                                                         Credit card repayments
                                                                                                                                                $                               per month
                                                                                               Rent/board
                                                 $                                per month                                                     $                               per month
Total Income                                                                                   General living expenses
                                                                                                                                                $                               per month
Assets                                                                                         Other (please specify)
                                                 $
Home
                                                 $                                                                                              $                               per month
Investments (eg. shares)                                                                       Total Expenditure
                                                 $
Motor vehicles                                                                                 Liabilities
                                                 $                                                                                              $
Other Assets (please specify)                                                                  Home loan
                                                                                                                                                $
                                                                                               Other loans
                                                 $                                                                                              $
Total Assets                                                                                   Credit cards
                                                                                                                                                $
                                                                                               Other (please specify)


                                                                                                                                                $
                                                                                               Total Liabilities
Director’s Declaration: I the undersigned applicant authorise the establishment of the programme; the issuance of ANZ Commercial cards; nominate myself to collect cards, reports,
statements and other communications as necessary; and authorise ANZ to issue ANZ Commercial cards as detailed above. I agree and acknowledge that my signature below evidences
my understanding and consent to all matters set out in this form, including the Declaration overleaf. I declare that the credit to be provided by ANZ is wholly or predominantly for
business purposes and that I have understood this application, including the Declaration below. I con rm by signing this application form that I am aware that, if this application is
approved, I will be accepting the ANZ Commercial Cards Terms and Conditions, Fees and Charges and Letter of O er when a card is linked to the Principal’s Billing Account is rst used.
IMPORTANT: You should not sign this declaration unless this loan is wholly or predominantly for business or investment purposes. By signing this declaration you may lose your
protection under the National Credit Code.

Director 1 Signature                                                                      Print Name                                                       Date (DD/MM/YYYY)


  ✗
Note: If a partnership, all partners must sign. If a company, a minimum of two directors must sign unless a sole director company. If a sole trader, the principal must sign.
A duly authorised o cer can only sign if the o cer is speci ed in the account opening authority or is otherwise authorised in writing (and signed) by the business.


Australia and New Zealand Banking Group Limited (ANZ) ABN 11 005 357 522.                                                                                                         Page 2 of 4
ANZ Business One Visa Credit Card Application



4. DIRECTOR DETAILS DIRECTOR 2

Title                  Given name/s                                                             Home address

Surname
Date of birth                         Aust.Driver’s licence number
                                                                                                Suburb                                     State                   Postcode
                                                                                                Previous address (if at current address less than 3 years)
Are you an existing ANZ customer?                                           Yes      No

Number of dependants                                                                            Suburb                                     State                   Postcode
Marital Status                                       Single    Defacto         Married
                                                                                                Contact number (mobile preferred)
Card Details
Card Required?                Yes       No
Monthly Spend Cap             Unlimited         Preferred amount           $
Please nominate your monthly spend cap (card limit) as ‘unlimited’ or a preferred amount.
’unlimited’ allows the cardholder full access to available account credit.

Cardholder name as you wish it to appear on card (max. 19 characters inc. spaces)


Security Code^
^ For verbal identi cation purposes eg. a word meaningful only to you.

Personal Finances
Income                                                                                         Expenditure
                                                 $                                per month                                                     $                               per month
Salary/wages (gross)                                                                           Home loan repayments
                                                 $                                per month                                                     $                               per month
Rent received                                                                                  Other loan repayments
                                                 $                                per month                                                     $                               per month
Other (please specify)                                                                         Credit card repayments
                                                                                                                                                $                               per month
                                                                                               Rent/board
                                                 $                                per month                                                     $                               per month
Total Income                                                                                   General living expenses
                                                                                                                                                $                               per month
Assets                                                                                         Other (please specify)
                                                 $
Home
                                                 $                                                                                              $                               per month
Investments (eg. shares)                                                                       Total Expenditure
                                                 $
Motor vehicles                                                                                 Liabilities
                                                 $                                                                                              $
Other Assets (please specify)                                                                  Home loan
                                                                                                                                                $
                                                                                               Other loans
                                                 $                                                                                              $
Total Assets                                                                                   Credit cards
                                                                                                                                                $
                                                                                               Other (please specify)


                                                                                                                                                $
                                                                                               Total Liabilities
Director’s Declaration: I the undersigned applicant authorise the establishment of the programme; the issuance of ANZ Commercial cards; nominate myself to collect cards, reports,
statements and other communications as necessary; and authorise ANZ to issue ANZ Commercial cards as detailed above. I agree and acknowledge that my signature below evidences
my understanding and consent to all matters set out in this form, including the Declaration overleaf. I declare that the credit to be provided by ANZ is wholly or predominantly for
business purposes and that I have understood this application, including the Declaration below. I con rm by signing this application form that I am aware that, if this application is
approved, I will be accepting the ANZ Commercial Cards Terms and Conditions, Fees and Charges and Letter of O er when a card is linked to the Principal’s Billing Account is rst used.
IMPORTANT: You should not sign this declaration unless this loan is wholly or predominantly for business or investment purposes. By signing this declaration you may lose your
protection under the National Credit Code.

Director 2 Signature                                                                      Print Name                                                       Date (DD/MM/YYYY)


  ✗
Note: If a partnership, all partners must sign. If a company, a minimum of two directors must sign unless a sole director company. If a sole trader, the principal must sign.
A duly authorised o cer can only sign if the o cer is speci ed in the account opening authority or is otherwise authorised in writing (and signed) by the business.


Australia and New Zealand Banking Group Limited (ANZ) ABN 11 005 357 522.                                                                                                         Page 3 of 4
ANZ Business One Visa Credit Card Application


6. ADDITIONAL CARDHOLDER

Title                                  Given name/s                                              Surname


Date of birth                         Security Code^
                                                                                                 ^ For verbal identi cation purposes eg. a word meaningful only to you.

Cardholder name as you wish it to appear on card (max. 19 characters inc. spaces) Phone number (mobile number preferred)


Monthly Spend Cap Unlimited                       Preferred amount              $
Please nominate your monthly spend cap (card limit) as ‘unlimited’* or a preferred amount. ’unlimited’ allows the cardholder full access to available account credit.

Cardholder 1 Signature                                                                     Print Name                                                       Date (DD/MM/YYYY)


  ✗
7. FINANCIAL INFORMATION CHECKLIST                                                              8. SUBMITTING THIS FORM
If your business has been operating for less than one nancial year,                             Once you have completed the application form, please send it to ANZ
please provide:                                                                                 Commercial Cards via:
Business plan detailing industry and speci c business management
                                                                                                          Fax to: 1800 457 304
experience, AND
                                                                                                           or
12 months cash ow forecast
                                                                                                          Mail to: ANZ Commercial Cards, REPLY PAID 65798,
If your business has been operating for at least one nancial year,
                                                                                                          Locked Bag 10, Collins Street West Post O ce, Melbourne VIC 8007
please provide:
                                                                                                          or
1 year Pro t/Loss & Balance Sheets and associated notes
                                                                                                          Deliver to: any ANZ branch
9. DECLARATION
ANZ’s collection, use and disclosure of personal information                                     or services. Where you do not want ANZ to tell you about its products or services or
In the following declaration ANZ is Australia and New Zealand Banking Group Limited              those of its related companies or alliance partners, you may withdraw your consent by
ABN 11 005 357 522.                                                                              calling 13 22 73 at any time.
Application for commercial credit                                                                Personal Information
ANZ may obtain a credit report containing your personal information and use in                   Your agreement to the use and disclosure of your personal information applies to any
assessing this application.                                                                      personal information collected by ANZ in the course of your relationship with ANZ.
ANZ’s collection, use and disclosure of personal information                                     ANZ Business One Visa Rewards Points
ANZ is collecting your personal information to enable it to assess your application and,         If you have chosen the ANZ Business One Visa – Rewards option, the points will be
if it is approved, to provide you with the product you are applying for. Without this            consolidated at the Billing Account level. Reward Points and Bonus Reward points
information we may not be able to process your application or if you are approved,               accrue in accordance with the ANZ Business One Visa Reward Terms and Conditions and
provide you with the product.                                                                    Bonus Partner Terms & Conditions.
ANZ may disclose your personal information to:                                                   ANZ Business One Visa – Cash Rewards
• any service provider ANZ engages to carry out or assist its functions and activities;          If you have chosen the ANZ Cash Rewards option, ANZ Cash Rewards are earned in
• any third party providing you with a product or service in relation to the ANZ product;        accordance with the ANZ Business One Visa Cash Rewards Terms & Conditions.
• credit reporting agencies;
• your referee; and                                                                              Additional Cardholder/s
• any credit provider to assess a credit application, to assess your credit worthiness, to       I/we acknowledge that, as Principal/s, I/we are responsible for all transactions made
  help you avoid default on your obligations or to inform them of your default.                  on the ANZ Business One Visa account by the Additional Cardholder. I/we also
                                                                                                 acknowledge that the Additional Cardholder may request his/her own PIN, access the
By signing this application form, you consent to ANZ disclosing your information to              account electronically via telephone banking and obtain information about the status
these persons.                                                                                   of the cardholder’s account and transactions made on the cardholder’s account. I/
You may request access to your information by calling 13 22 73. Access will be granted           we acknowledge that I/we can request to block or cancel the Additional Cardholder’s
in accordance with the Privacy Act 1988 for a reasonable fee. If any of your information         card and that, in respect of a cancelled card, I/we will remain liable for the Additional
is inaccurate, you may request that it be corrected.                                             Cardholder’s use of the card until the card is returned to ANZ.
                                                                                                 Identi cation Requirements
Promotion of other products or services
                                                                                                 I understand that before a card is issued I will need to be identi ed by ANZ’s Customer
ANZ may use your personal information to promote its products or those of its related
                                                                                                 Identi cation Process in accordance with the Anti-Money Laundering and Counter-
companies and alliance partners and may disclose your personal information to its
                                                                                                 Terrorism Financing Act (Cth) 2006.
related companies or alliance partners to enable them or ANZ to market their products


BANK USE ONLY
Approving/Submitting officer’s name                                         Area code            Contact number                       Email address


ANZSIC code                                                                 Client Number (CLG)                                       Domicile BSB


CPID/Set number                         OLL number/LA number                Signature of approving/submitting officer                 Date (DD/MM/YY)                   Source Code
                                                                                                                                                                          ICWE
                                                                              ✗
Australia and New Zealand Banking Group Limited (ANZ) ABN 11 005 357 522. ANZ’s colour blue is a trade mark of ANZ. Item No. 59684 02.2011 W221006                                Page 4 of 4

				
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