Landfix | Credit Application

Credit Accounts are only available to commercial clients who hold a valid ABN or ACN.

Warning:

Parts of the following application form a legally binding agreement between the named parties.

Landfix advises that you seek independant legal advice prior to signing and completing this application.

Business Information
Legal Name*
Trading Name*
ABN*
11 characters consisting of numbers only.
Which of the following best describes your business?*

Sole TraderPartnershipProprietary Company
Legal Entity Name*
ACN*
9 characters consisting of numbers only.
How many owners/partners/directors?*
Date Established*

DayMonthYear
Requested Credit Limit*

Business Information
Company Representative (person making the application for and on behalf of the business)*

First NameLast Name
Photo Identification (Licence or ID Card)*

Browse Files

Cancelof
Business Address*

Street Address

Line 2

SuburbState

Post Code
Do you have a different postal address?*

YesNo
Postal Address*

Street Address

Line 2

SuburbState

Post Code
Land Line Number*

Area CodePhone Number
Mobile Number*

Area CodePhone Number
Email*

Confirmation Emailexample@example.com

Owner/Partner/Director Details
Owner/Partner/Director
Name*

First NameLast Name
Home Address*

Street Address

Line 2

SuburbState

Post Code
Personal Phone Number*

Area CodePhone Number

Owner/Partner/Director 2.
Name*

First NameLast Name
Home Address*

Street Address

Line 2

SuburbState / Province

Post Code
Personal Phone Number*

Area CodePhone Number

Owner/Partner/Director 3.
Name*

First NameLast Name
Home Address*

Street Address

Line 2

SuburbState / Province

Post Code
Personal Phone Number*

Area CodePhone Number

Owner/Partner/Director 4.
Name*

First NameLast Name
Home Address*

Street Address

Line 2

SuburbState / Province

Post Code
Personal Phone Number*

Area CodePhone Number

Owner/Partner/Director 5.
Name*

First NameLast Name
Home Address*

Street Address

Line 2

SuburbState / Province

Post Code
Personal Phone Number*

Area CodePhone Number

Owner/Partner/Director 6.
Name*

First NameLast Name
Home Address*

Street Address

Line 2

SuburbState / Province

Post Code
Personal Phone Number*

Area CodePhone Number

Owner/Partner/Director 7.
Name*

First NameLast Name
Home Address*

Street Address

Line 2

SuburbState / Province

Post Code
Personal Phone Number*

Area CodePhone Number

Owner/Partner/Director 8.
Name*

First NameLast Name
Home Address*

Street Address

Line 2

SuburbState / Province

Post Code
Personal Phone Number*

Area CodePhone Number

Owner/Partner/Director 9.
Name*

First NameLast Name
Home Address*

Street Address

Line 2

SuburbState / Province

Post Code
Personal Phone Number*

Area CodePhone Number

Owner/Partner/Director 10.
Name*

First NameLast Name
Home Address*

Street Address

Line 2

SuburbState / Province

Post Code
Personal Phone Number*

Area CodePhone Number

Sole Trader Details
Name*

First NameLast Name
Home Address*

Street Address

Line 2

SuburbState / Province

Post Code
Personal Phone Number*

Area CodePhone Number

Administrative Contact Information
Administration Contact 1.
Name*

First NameLast Name
Position*
Other*
Phone Number*

Area CodePhone Number
Email*

Confirmation Emailexample@example.com
Would you like to list another Administration contact?*

YesNo

Administration Contact 2.
Name

First NameLast Name
Position
Other
Phone Number

Area CodePhone Number
Email*

Confirmation Emailexample@example.com

Trade References
Reference 1.
Business Name*
Address*

Street Address

Line 2

SuburbState / Province

Post Code
Phone Number*

Area CodePhone Number
Email*

Confirmation Emailexample@example.com
Account ID

Reference 2.
Business Name*
Address*

Street Address

Line 2

SuburbState / Province

Post Code
Phone Number*

Area CodePhone Number
Email*

Confirmation Emailexample@example.com
Account ID

Fine Print
Signature*

Clear
Name*

First NameLast Name
Date*

DayMonthYearHourMinutesAM/PM Option
Should be Empty: