Application Form

APPLICATION FOR CREDIT

RM_Stats

Account Details

Email ^*

Username ^*

Password ^*

Password must be at least 7 characters long.

Enter password again ^*

Password must be at least 7 characters long.

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Applicant Details

Full Name of Applicant ^*

ACN/ABN ^*

Trading Name ^*

Indicate Legal Structure of Applicant ^*

• Company
• Partnership
• Sole Trader
• Trustee of a Trust
• Other

Trust Name

Business Street Address ^*

Business Postal Address ^*

Contact Person ^*

Phone ^*

FAX

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Contact & Business Details

1. Director/Partner/Sole Trader

Full Name ^*

D.O.B ^*

Title/Position ^*

Drivers License ^*

Address ^*

Mobile ^*

2. Director/Partner/Sole Trader

Full Name

D.O.B

Title/Position

Drivers License

Address

Mobile

Purchasing Contact Person ^*

Accounts Payable Contact Person ^*

Date Business Commenced ^*

Expected Monthly Purchases ^*

Nature of Business ^*

Any judgement entered against Applicant in last 4 years

Name of Bank

Branch

Account No.

BSB

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Trade References

Provide the two current main trade suppliers

Name ^*

Telephone ^*

Address ^*

Contact Person ^*

Name ^*

Telephone ^*

Address ^*

Contact Person ^*