Credit Application For A Business Account

Step 1 of 4

BUSINESS CONTACT INFORMATION

Business Name(Required)

Business Address(Required)

Business Type(Required)

Phone

Mobile

Fax

ABN#

Email(Required)

ACN#

If Company; Registered company address, City, State, Postcode

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Title e.g.; director, owner etc.

Directors/Owners Name(s)

Directors/Owners Addresses

D/L #

Account Terms(Required)

COD

7 Days

14 Days

30 Days EOM Credit Limit Request

Credit Limit Request(Required)

DOES YOUR COMPANY USE PURCHASE ORDERS(Required)

YES

AUTHORITY TO USE ACCOUNT NAME/NAMES

ACCOUNTS PAYABLE DETAILS

Accounts Payable Name(Required)

Accounts Payable Address(Required)

Street Address City State / Province / Region ZIP / Postal Code Country

Accounts Payable Email(Required)

Accounts Payable Phone(Required)

Would you like invoices and statements emailed?(Required)

YES

BUSINESS AND CREDIT INFORMATION

Legal Entity Name(Required)

Primary Business Address(Required)

Street Address City State / Province / Region ZIP / Postal Code Country

Date business commenced(Required)

Sole proprietorship

Partnership

Corporation

Other

How long at current address?(Required)

Rented/Leased

Owned

Mortgaged

BUSINESS/TRADE REFERENCES

1. Company name

Address

Street Address City State / Province / Region ZIP / Postal Code Country

Type of account e.g.; 7 days, 30 days EOM etc.

Phone

Fax

Other

2. Company name

Address

Street Address City State / Province / Region ZIP / Postal Code Country

Type of account e.g.; 7 days, 30 days EOM etc.

Phone

Fax

Other

3. Company name

Address

Street Address City State / Province / Region ZIP / Postal Code Country

Type of account e.g.; 7 days, 30 days EOM etc.

Phone

Fax

Other

HISTORY OF INSOLVENCY

During the previous five years has there been judgment, legal proceedings (Including bankruptcy) or a claim made against any principals, directors or the undersigned or is one current, pending or threatened?(Required)

YES

If yes, please provide a separate statement.(Required)

AGREEMENT

1. All invoices are to be paid with account terms approved.

2. Claims arising from invoices must be made within fourteen working days.

3. By submitting this application, you authorize WA Reticulation Supplies to make inquiries into the banking and business/trade references that you have supplied.

4. In signing this credit application document the applicant(s) agrees to the terms of the Privacy Act 1988 and the authorization contained in this document.

TRADING TERMS AGREEMENT

All payments are to be made within the trading terms set out in the Account Approved letter issued once approval is in place.

The Customer must pay for all goods within the time specified and has no right to withhold any monies beyond such time.

All amounts not paid within the agreed credit period shall bear interest at the overdraft rate charged by the Companies principal bankers in respects of amounts of $100,000 from invoice date until payment plus all costs, charges and expenses which may be incurred by the company in the exercise or attempted exercise of any remedy. All amounts received by the company will be credited first against interest and then against said costs, charges and expenses.

The Company may terminate the account at any time (whether or not the Customer is in breach of any payment terms) by giving the Customer notice in writing.

The Customer acknowledges and agrees that the Company may withhold supplies if any amount owing by the customer is overdue and unpaid whether in whole or part.

The Customer shall pay the Company all costs, commissions, legal expenses and all other expenses incurred by the Company in collecting any monies outstanding and payable by the Customer to the Company.

The Customer shall immediately after its occurrence notify the Company in writing of any change in Shareholding or proprietorship and the Customer as the case may be shall indemnify the Company in respect of any loss arising from the Customers failure to do so.

If at any time, monies are overdue, the whole account then becomes due and the Company is justified in proceeding legally to recover the whole debt.

Until payment in full the Company retains legal & equitable title and the purchaser remains Bailee of The materials supplied and to the extent of the Companies interest any other objects into which the materials supplied may be incorporated and any proceeds from the sale of materials supplied of the other objects.

The Customer acknowledges having received a copy of specific terms & conditions relating to the sale.

Consent

I agree to the above terms