APPLICANT BUSINESS DETAIL
REGISTERED COMPANY NAME
*
TRADING NAME
*
ABN/ACN
*
BUSINESS ADDRESS
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
MAIN CONTACT
*
First Name
Last Name
MAIN CONTACT POSITION
*
MAIN CONTACT PHONE
*
Please enter a valid phone number.
Format: (000) 000-0000.
MAIN BUSINESS PHONE
*
Please enter a valid phone number.
Format: (000) 000-0000.
MAIN BUSINESS EMAIL
*
example@example.com
DIRECTOR/ OWNER DETAILS
NAME
*
First Name
Last Name
EMAIL
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
ADDRESS
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
DRIVER LICENCE NUMBER
*
DRIVER LICENCE ISSUED BY
*
Please Select
NEW SOUTH WALES
QUEENSLAND
VICTORIA
A.C.T
WESTERN AUSTRALIA
NORTHERN TERRITORY
SOUTH AUSTRALIA
TASMANIA
OTHER
NAME (2)
First Name
Last Name
EMAIL (2)
example@example.com
Phone Number (2)
Please enter a valid phone number.
Format: (000) 000-0000.
ADDRESS (2)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
ACCOUNTS PAYABLE
NAME
*
First Name
Last Name
PHONE NUMBER
*
Please enter a valid phone number.
Format: (000) 000-0000.
EMAIL
*
example@example.com
ORDERING AND DELIVERY
NAME
*
First Name
Last Name
PHONE NUMBER
*
Please enter a valid phone number.
Format: (000) 000-0000.
EMAIL
*
example@example.com
DELIVERY ADDRESS
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
SITE OPERATING HOURS (DELIVERY)
HANDLING FEE- All orders they will be an admin charge of $1.10 and fuel levy of $2.50 which will cover the delivery cost, handling charges and fuel cost which will appear on every invoice. ORDERS- All orders must be placed before 4.30pm on the day prior to delivery. All orders placed on Sunday must be between 2pm – 4.30pm.Please note all order for cakes and pastries need to be in before 4.00pm. Customers are obliged to organise a safe delivery area and notify the Company of the exact in advance
*
I AGREE
MORE INFO
PRINCIPAL BUSINESS ACTIVITY
IS THE BUSINESS A FRANCHISE OR PART OF A GROUP
YES
NO
HOW MANY SITES REQUIRE SUPPLY
ACKNOWLEDGEMENT OF TERMS AND PAYMENT
TERMS OF AGREEMENT 1. I/We (the Guarantor) understand that the terms of payment are strictly payment prior to delivery; COD or if arranged otherwise (in writing) with COSMOPOLITAN CORPORATION AU Pty Ltd. 2. I/We the Guarantor) agree COSMOPOLITAN CORPORATION AU Pty Ltd reserves the right to charge late payment fee of 2% on the outstanding balance per week from the date it becomes overdue until paid. 3. I/We the Guarantor) agree COSMOPOLITAN CORPORATION AU Pty Ltd reserves the right to withhold supply of further product dispatches until payment is received in full and account is brought up-to-date. 4. I/We (the Guarantor) represents and warrants to COSMOPOLITAN CORPORATION AU Pty Ltd that the information contained herein is true and correct to best of its knowledge5. I/We (the Guarantor), the above also agree to personally guarantee in full the immediate payment of debt incurred in the event of default by the applicant(s)/company. 6. I/We (the Guarantor) agree to pay to COSMOPOLITAN CORPORATION AU Pty Ltd costs and disbursements incurred in recovering monies secured by this deed, including debt recovery agency fees and legal costs on an indemnity basis. 7. I/We (the Guarantor) acknowledge having read and agreed to the terms and conditions stated herein:
*
I AGREE
NAME
*
First Name
Last Name
POSITION
*
DATE
*
-
Month
-
Day
Year
Date
SIGNATURE
*
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