Page 1 of 4
Date:
/
/ 20
CREDIT APPLICATION APPLICANT DETAILS (please print) Registered Name.
Trading As.
REGISTERED BUSINESS TYPE (please tick) Sole Trader
Partnership
Pty Ltd Co.
Public Company
Govt. Body
Trust Company
Delivery Address.
Postcode.
Phone. Fax. Email. Website.
ABN #. ACN #. Years Established.
www.dlc.com.au Email: info@dlc.com.au dlc australia pty ltd ACN 005 271 278 ABN 15 262 611 639
17 - 19 Horne Street Hoppers Crossing VIC 3029
Unit 6/1 Lear Jet Drive Caboolture QLD 4510
Telephone (03) 9360 9700 Facsimile (03) 9360 9994 PO Box 4438 Hoppers Crossing VIC 3029 Country & Interstate Orders Only Free Call 1300 785 405
Telephone (07) 5428 3666 Facsimile (07) 54 28 3777 PO Box 833 Caboolture QLD 4510 Country & Interstate Orders Only Free Call 1300 785 401
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Accounts Address.
Postcode.
Accounts Contact Name Phone.
Fax.
Email.
TRADE REFERENCES 1. Name. Phone. Fax. Email.
2. Name. Phone. Fax. Email.
3. Name. Phone. Fax. Email.
www.dlc.com.au Email: info@dlc.com.au dlc australia pty ltd ACN 005 271 278 ABN 15 262 611 639
17 - 19 Horne Street Hoppers Crossing VIC 3029
Unit 6/1 Lear Jet Drive Caboolture QLD 4510
Telephone (03) 9360 9700 Facsimile (03) 9360 9994
Telephone (07) 5428 3666 Facsimile (07) 54 28 3777
PO Box 4438 Hoppers Crossing VIC 3029 Country & Interstate Orders Only Free Call 1300 785 405
PO Box 833 Caboolture QLD 4510 Country & Interstate Orders Only Free Call 1300 785 401
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Credit Limit Request. Requested By.
CONDITIONS: In consideration of you granting credit I/We declare and agree to the following: A) The information given is true in all respects. B) I/We will promptly advise you in writing of any proposed changes in the business. C) The account will be a 14-day account and will be paid within the 14 days from the date of purchase. D) I/We will pay any expenses costs or disbursements incurred by you in recovering any outstanding monies including debt collection agency fees, solicitors and court costs as an addition to our account. It is agreed that DLC Australia P/L shall retain full right, title and interest to any goods supplied until payment in full is received for such goods.
We, (a)
(b)
(c)
(d)
Being the directors/proprietors* of the Customer (hereinafter called “The Customer”) in consideration of trading as (Hereinafter called “The Supplier) agreeing to supply the customer with goods from time to time HEREBY JOINTLY AND SEVERALLY GUARANTEE the payment to the supplier by the customer of all sums of money now due or owing or to become due or owing by the Customer to the supplier and HEREBY INDEMNIFY AND AGREE TO CONTINUE TO INDEMNIFY the supplier against all loss damage costs and expenses (including legal administrative and other costs charges and duties) which may be borne or incurred by the supplier as a result of failure by the customer to pay for the goods by the due date provided that no sum or sums of money received by the supplier for the credit of the Customer or in payment or on account of the indebtedness or liability of the Customer and for which the Supplier may in any insolvency of the Customer be obliged to account to any Liquidator, Official Manager, Receiver, Trustee or any other persons or may in its discretion so account shall be considered as received by the Supplier or discharge or diminish the liability of the Guarantors.
www.dlc.com.au Email: info@dlc.com.au dlc australia pty ltd ACN 005 271 278 ABN 15 262 611 639
17 - 19 Horne Street Hoppers Crossing VIC 3029
Unit 6/1 Lear Jet Drive Caboolture QLD 4510
Telephone (03) 9360 9700 Facsimile (03) 9360 9994 PO Box 4438 Hoppers Crossing VIC 3029 Country & Interstate Orders Only Free Call 1300 785 405
Telephone (07) 5428 3666 Facsimile (07) 54 28 3777 PO Box 833 Caboolture QLD 4510 Country & Interstate Orders Only Free Call 1300 785 401
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DATED the
day of
20
SIGNED SEALED AND DELIVERED by the Said ) In the presence of )
DATED the
day of
Witness
20
SIGNED SEALED AND DELIVERED by the Said ) In the presence of )
DATED the
day of
Witness
20
SIGNED SEALED AND DELIVERED by the Said ) In the presence of )
DATED the
day of
Witness
20
SIGNED SEALED AND DELIVERED by the Said ) In the presence of )
www.dlc.com.au Email: info@dlc.com.au dlc australia pty ltd ACN 005 271 278 ABN 15 262 611 639
Witness
17 - 19 Horne Street Hoppers Crossing VIC 3029
Unit 6/1 Lear Jet Drive Caboolture QLD 4510
Telephone (03) 9360 9700 Facsimile (03) 9360 9994
Telephone (07) 5428 3666 Facsimile (07) 54 28 3777
PO Box 4438 Hoppers Crossing VIC 3029 Country & Interstate Orders Only Free Call 1300 785 405
PO Box 833 Caboolture QLD 4510 Country & Interstate Orders Only Free Call 1300 785 401