Drake Application For Credit Form

Page 1

Application for credit

COMPLETE ONE SECTION ONLY – APPLICABLE TO YOUR ENTITY FAX COMPLETED FORM THEN MAIL ORIGINAL TO DRAKE (SEE PAGE 2 FOR DETAILS)

Credit Application Version No: 3 Issue Date: October 2006 :: 1 of 2
COMPANY: Company Name: ABN: Trading as: Industry Type: Postal Address: Business Address: Telephone: Facsimile: Account Contact Title: Name of Directors 1: 4: 2: 5: 3: 6: Place of Incorporation Date: PARTNERSHIP: Business Name: ABN: Industry Type: Postal Address: Business Address: Partners Name & Address 1: 2: 3: 4: Telephone: Facsimile: Contact Title: How long has business been operating? Years: Months: SO l E TRADER : Business Name: ABN: Industry Type: Postal Address: Business Address: Proprietors Name: Address: Telephone: Facsimile:
Months:
u NT
CREDIT MONTH lY $:
How long has business been operating? Years:
AMO
OF
DRAKE AUSTRALIA PTY LTD (ACN 004 939 771)

1. DRAKE AUSTRALIA PTY LTD (ABN 42 004 939 771) shall hereinafter be referred to as the CREDIT PROVIDER.

2 The Applicant hereby acknowledge that they have been informed by the CREDIT PROVIDER that personal information about them may be disclosed to or acquired from a credit reporting agency

3 The Applicant hereby acknowledge that they have been informed that personal information about them may be disclosed by the CREDIT PROVIDER to a credit reporting agency

4 The Applicant hereby agrees that the CREDIT PROVIDER may contact any trade references or other credit references at any time whether now or in the future for the purpose of assessing credit worthiness.

5. The Applicant hereby agrees to the CREDIT PROVIDER receiving from any other credit provider or providing to any other credit provider any credit information whether by way of report record or otherwise relating to credit worthiness for the purposes

6 The Applicant hereby agrees to the CREDIT PROVIDER obtaining from a credit reporting agency a credit report on the applicant for the purpose of assessing this credit application and the applicant further consents to the CREDIT PROVIDER obtaining such reports from time to time for the purpose of assessing credit worthiness during the continuance of credit provision

7. The Applicant hereby agrees to it’s CREDIT PROVIDER obtaining from a business which provides credit information a report on information in relation to my/our commercial credit worthiness or commercial dealings and using such information for the purposes of assessing this application for credit.

8 The Applicant hereby agrees that in the event of default of payment of it’s debts that the CREDIT PROVIDER may disclose all information relating to the applicant/s account to its collection agency for the purpose of receiving any or all amounts outstanding

D R AKE A U S T R ALIA P TY L T D ( A C N 0 0 4 939 771 )
Credit Application Version No: 3 Issue Date: October 2006 :: 2 of 2 Signature Print Name Title Date PL E A S E R E AD T H E F OL L O W I NG C A R E F U L LY P R I V A C Y A C T 19 8 8 D R AK E A U S T R A LI A P TY LT D ( A B N 42 0 0 4 939 771 ) Level 41, 55 Collins St, Melbourne Vic 3000 F ax : 0 3 9639 6 8 35 Phon e : 1 3 00 65 8 711 ( C r edi t M ana g e r ) c r edit @au .d r a k ei n tl. c o m T R AD E R EFE R E N C E S : T h r ee t o b e s upp lied (M a j or S upp lie r s On ly ) 1: Suburb: Ph: 2 : Suburb: Ph: 3 : Suburb: Ph: NOTE: Payment terms of 7 DAYS for Temp. placement and 14 DAYS for other invoices from invoice date.

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