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WHOLESALE
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Wholesale Registration
Credit Account Application Form
Buyer Details
Company Name
*
ACN
*
ABN
*
Type of company
*
Private Company
Partnership
Sole Trader
Trust
Registered Business or Trading Name
*
Delivery Address
Street Address
Address Line 2
City
NT
ACT
NSW
QLD
VIC
WA
SA
TAS
State
Postcode
Contact Name:
*
First
Last
Phone No
Email Address
*
Business Details
Business Commencement Date
*
Date Format: DD slash MM slash YYYY
Payment Method
*
Payment Method
Paypal
Invoice
Is the business premises
*
Owned
Leased
Mortgaged
Business Bank
*
BSB
*
A/C No
*
Anticipated Spend per Month
*
Trade History
Has Buyer ever been bankrupt or subject to external administration?
*
Yes
No
Provide Details
Trade Reference / Credit Providers
1. Trade Reference
*
Phone Number
Email
Checked - Comments
Add Another?
Yes
No
2. Trade Reference
2. Trade Reference
*
Phone Number
Email
Checked - Comments
Business Principals
1. Directors/ Partner Full Name
*
Phone Number
Address
Street Address
Address Line 2
City
NT
ACT
NSW
QLD
VIC
WA
SA
TAS
State
Postcode
Add Another?
Yes
No
2. Directors/ Partner
2. Directors/ Partner Full Name
*
Phone Number
Address
Street Address
Address Line 2
City
NT
ACT
NSW
QLD
VIC
WA
SA
TAS
State
Postcode
Add Another?
Yes
No
3. Directors/ Partner
3. Directors/ Partner Full Name
*
Phone Number
Address
Street Address
Address Line 2
City
NT
ACT
NSW
QLD
VIC
WA
SA
TAS
State
Postcode
Add Another?
Yes
No
4. Directors/ Partner
4. Directors/ Partner Full Name
*
Phone Number
Address
Street Address
Address Line 2
City
NT
ACT
NSW
QLD
VIC
WA
SA
TAS
State
Postcode
All Directors must complete if the buyer is a company, and all partners must complete if the buyer is a partnership
1. Full Name
*
Position
*
Date
*
Date Format: DD slash MM slash YYYY
Add Another?
Yes
No
2. Director / Partner
2. Full Name
*
Position
*
Date
*
Date Format: DD slash MM slash YYYY
Add Another?
Yes
No
3. Director / Partner
3. Full Name
*
Position
*
Date
*
Date Format: DD slash MM slash YYYY
Add Another?
Yes
No
4. Director / Partner
4. Full Name
*
Position
*
Date
*
Date Format: DD slash MM slash YYYY
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