Credit Application Form

5/88 Briggs Street WELSHPOOL WA 6106

0458 282 222 | accounts@partsportal.com.au

ACN 662 475 130 | ABN 60 662 475 130

ACCOUNT APPLICATION

COMPANY DETAILS

Registered Name:

Trading Name:

ABN:

ACN (if company):

Purchase Orders to be supplied: Yes No

Payment Method:

Billing Address:

Shipping Address:

Account Payable:

Accounts Email:

Purchasers Email:

Bank:

Monthly Credit Required:

TRADE REFERENCES

Company Name:

Contact Person:

Company Address:

Phone No:

Company Email:

Company Name:

Contact Person:

Company Address:

Phone No:

Company Email:

Company Name:

Contact Person:

Company Address:

Phone No:

Company Email:

TERMS & CONDITIONS

I/We understand and acknowledge that normal trading terms are strictly 30 days from end of month, unless a COD account, and that payment will be made immediately on receipt of invoice or purchase. In the month following purchase for all goods sold and delivered or services provided and further understand that upon reaching credit limit or if payment becomes overdue, supply and credit may be suspended until payment is received and cleared. I/We agree that all costs related to recovery of debts incurred shall be my/ our sole responsibility. These costs include any commissions paid to the debt recovery agent. I/We agree that notwithstanding any change in my trading structure, I/we will remain liable for goods and services requested by me/ us or my agents. I/We hereby declare that the information in this credit application is true and accurate to the best of my/our knowledge and authorization is hereby given to confirm and exchange credit information in relation to this application from any source.

Print Name:

Position Held:

Date:

Sign Application