Customer Application For Trade Account

Application for Trade Credit Account
A. BUSINESS CONTACT INFORMATION
Business / Clinic Name*
ABN Number*
Primary Sales Contact Name*
Job Title*
Phone*
Email*
Street Address*
Suburb/Town/City*
State*
Postcode*
B. ACCOUNTS PAYABLE INFORMATION (if different from above)
Billing Company
Accounts Contact
Phone
Accounts Email
C. DELIVERY ADDRESS (if different from contact information above)
Street Address
Suburb/Town/City
State
Postcode
D. BUSINESS/TRADE REFERENCES
1. Company Name
Contact Name
Address
City
State / Postcode
Phone
Email
Years Trading
2. Company Name
Contact Name
Address
City
State / Postcode
Phone
Email
Years Trading
E. PAYMENT AGREEMENT AND TERMS
All invoices are to be paid 30 days from date of the invoice. Any claims arising from invoices must be made within seven working days of receipt of invoice.

For full details regarding the Single Use Dental Instruments official Terms & Conditions please click here.
SIGNATURE
Clear
Name
Title
Date

DayMonthYear
APPROVAL PROCESS
Please note that the approval process can take up to 5 business days to process. If you would like to order immediately please do so with your credit card details during checkout.
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Application for Trade Credit Account