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Freight
Storage
About
03 9706 5491
PICKUP
QUOTE
Contact Us
CREDIT APPLICATION
Account/Company Name
*
Trading As:
*
Registered Office Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Main Business Phone
*
Contact Email
*
Postal Address if required
*
ABN
*
Contact Name
*
Nature of Business
*
Director Name
*
Director Contact Phone
*
Director DOB
*
Director Address
*
Director Drivers License#
*
Names of Other Directors
*
Monthly Credit Requirement $
*
Trade Reference 1
*
Trade Reference 1 - Name of Contact
*
Trade Reference 1 Phone
*
Trade Reference 1 Email
*
Trade Reference 2
*
Trade Reference 2 - Name of Contact
*
Trade Reference 2 Phone
*
Trade Reference 2 Email
*
Trade Reference 3
*
Trade Reference 3 - Name of Contact
*
Trade Reference 3 - Phone
*
Trade Reference 3 Email
*
Confirm
*
I/we hereby make this application for credit with Inter Capital Express Australia Pty Ltd, stating and acknowledging that the information herein is correct and that I am authorised by the applicant to give this information. I/we further authorise you to give information and to get information from all credit providers named in this application or a credit report issued by a credit reporting agency. I understand that this can include information about my credit worthiness, credit standing and credit history or credit capacity. I/we also acknowledge and agree to the terms of payment on our Invoice. In the event of collections costs and/or legal feed being incurred I/we agree to pay all such costs and also acknowledge that any monies outstanding beyond our payment terms may incur an overdue charge.
I agree
Thank you!
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