CREDIT APPLICATION FORM FOR NEW CUSTOMER
PART A - ENTITY
Company Name
*
Business or Trading Name
ABN/ACN
*
Address for delivery
*
Street Address Line 2
Suburb
State
Postcode
Shop Manager Contact email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Online Platform Administrator (Ordering) Email Address
*
example@example.com
Phone
*
Please enter a valid phone number.
Accounts Payable Contact (invoices) Email Address
*
example@example.com
Phone
*
Please enter a valid phone number.
Type of Entity (Tick Box)
*
Sole Trader
Partnership
Private Company
Public Company
PART B – BUSINESS PROFILE
Type of Business (Cafe, bakery, Juice bar, etc)
*
Year Business Commenced
*
Name of Bank
*
Branch
*
Account Name/Number
*
PART C – TRADE REFERENCES
Trade Reference 1
Business Name
*
Contact Name
*
Phone Number
*
Trading Terms
*
Trade Reference 2
Business Name
*
Contact Name
*
Phone Number
*
Trading Terms
*
Trade Reference 3
Business Name
*
Contact Name
*
Phone Number
*
Trading Terms
*
TRADING TERMS:
1. Payment in full is required within 7 days from date of invoice.
2. Where more than one party is liable for payment of this account, they will be liable jointly and severally
3. Reference to an individual includes reference to heirs and executors and reference to a company shall include its receivers, administrator and liquidator.
4. The customer agrees that the information provided in this application is true and correct.
5. Orders are subject to the terms and conditions notified to the customer from time to time.
Signature of Authorised person
(Print full name)
*
First Name
Last Name
Position Held
*
Date
*
-
Month
-
Day
Year
Select preferred payment method
*
Debit/Credit card deduction (Merchant fees apply*)
Bank transfer
* Amex 2.2% + GST | Mastercard / Visa 1.4% + GST
DIRECTORS GUARANTEE AND INDEMNITY
The Guarantor(s) named below (“the Guarantors”) in consideration of the Supplier (“the Supplier”) providing credit to the Customer (“the Customer”) at our request DO HEREBY for ourselves and our respective executors and administrators jointly and severally covenant with the Supplier that if at any time default shall be made in the payment of any monies payable by the Customer to the Supplier we will forthwith on demand by the Supplier pay to it the whole of such monies which shall then be due and payable to the Supplier and will keep the Supplier indemnified against all losses, costs, charges and expenses whatsoever which the Supplier may incur by reason of any default on the part the Customer in complying with the terms and condition of the Supplier and this is a continuing indemnity.
The Supplier:
Name: Food Court Pty Ltd t/as Food and Dairy Co ABN: 78 600 617 972Address: PO BOX 3644 Rouse Hill NSW 2155
The Customer:
*
Business Name
ABN
Business Address
*
The Guarantors 1
Name
*
First Name
Last Name
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date of Birth
*
-
Month
-
Day
Year
Date
Driver’s Licence Number
*
Email
*
example@example.com
Mobile Number
*
Please enter a valid phone number.
The Guarantors 2
Name
First Name
Last Name
Home Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date of Birth
-
Month
-
Day
Year
Date
Driver’s Licence Number
Email
example@example.com
Mobile Number
Please enter a valid phone number.
SIGNED SEALED AND DELIVERED BY THE SAID: (Customer)
*
Name
*
First Name
Last Name
Date
*
-
Month
-
Day
Year
Date
IN THE PRESENCE OF:
*
Witness Name
*
First Name
Last Name
Date
*
-
Month
-
Day
Year
Date
Please confirm Account Manager if know
*
Emily S
Mark C
Matt G
Brenton B
Other
How did you hear about us?
*
Social Media
Sales Rep visit
Peer Recommendation - WOM
Google
Other
Submit
Should be Empty: