Kaffeina Group Credit Application

Kaffeina Group Pty Ltd

Commercial credit application
Kaffeina Group Pty Ltd
ABN 94 152 310 999

This Account Application Form is issued by Kaffeina Group Pty Ltd (ABN 94 152 310 999) ("Kaffeina Group"), which operates under the following trading names:
- Kaffeina Group – kaffeina.com.au
- 36th Parallel Coffee Roasters – 36parallelcoffee.com.au
- Ublend – ublend.com.au
- The Little Guy – lovethelittleguy.com
- This application applies to all products and services supplied by Kaffeina Group Pty Ltd under the above trading names.
By completing this Application, you are applying for a business trading account with Kaffeina Group Pty Ltd as the legal entity operating under these trading names.

This form requests key business and financial information to enable Kaffeina Group Pty Ltd to:
- Establish and manage an ongoing trading relationship;
- Assess your business and determine your suitability for a business trading account;
- Assess your eligibility for credit facilities, where requested or considered appropriate;
- Determine any applicable trading terms and, where approved, any credit limit.
- All information provided will be treated as confidential and used solely for the purposes of account establishment, credit assessment (where applicable), and ongoing account management.
Submission of this application does not guarantee approval of a business trading account or the granting of credit. Kaffeina Group Pty Ltd may approve a business trading account with or without credit facilities, at its sole discretion. Any goods supplied and any credit provided will be subject to Kaffeina Group Pty Ltd's Terms and Conditions of Sale, as amended from time to time.
Business structure
Full legal name (Applicant)
Your company name
Is Trading name different ?
Trading name
Your company name
ABN
Address

Street Address

Street Address Line 2

CityState

Post CodeCountry
Type of business
Phone Number
Format: (00) 0000-0000.
Directors name

First NameLast Name
Directors Mobile Number
Format: (0000) 000-000.
Directors E-mail
example@example.com
Add another Director ?
Director 2 name

First NameLast Name
Mobile Number Director 2
Format: (0000) 000-000.
E-mail Director 2
example@example.com
Add another Director ?
Director 3 name

First NameLast Name
Mobile Number Director 3
Format: (0000) 000-000.
E-mail Director 3
example@example.com

Business Credit Information

Accounts Payable contact if different to Business contact
Accounts Payable details - As per above
Accounts Payable Contact

First NameLast Name
Accounts Payable Phone
Format: (00) 0000-0000.
Accounts Payable Mobile Phone
Format: (0000) 000-000.
E-mail
example@example.com
Bill to Address

Street Address

Street Address Line 2

CityState / Province

Post CodeCountry

Bank Contact Information
Bank Name
Bank Contact - if known

First NameLast Name
Bank Address

Street Address

Street Address Line 2

CityState / Province

Post CodeCountry
Bank Phone Number
Format: (00) 0000-0000.

Business Trade References
Reference 1: Company Name
Contact person

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Post CodeCountry
Phone Number
Format: (00) 0000-0000.
Mobile Number
Format: (0000) 000-000.
E-mail
example@example.com
Type of Account
Reference 2: Company Name
Contact person

First NameLast Name
Address 2

Street Address

Street Address Line 2

CityState / Province

Post CodeCountry
Phone Number 2
Format: (00) 0000-0000.
Mobile Number 2
Format: (0000) 000-000.
E-mail 2
example@example.com
Type of Account 2

Acknowledgement and Agreement

By checking the boxes below, you confirm that you have read and agree to the terms and conditions.
AUTHORISED TO MAKE COMMITMENTS
APPLICATION IS COMPLETE AND CORRECT.
CREDIT REPORTS AND TRADE REFERENCES
PRIVACY AND CREDIT INFORMATION CONSENT
PAYMENT GUARANTEE

In consideration of Kaffeina providing goods or services on credit to the Applicant, I/we guarantee payment of all amounts the Applicant owes to Kaffeina. If the Applicant does not pay an amount when it is due, I/we will pay that amount on demand.This guarantee continues until all amounts owing to Kaffeina have been paid in full. If more than one person signs, each of us is jointly and individually responsible for the full amount owed.
INSOLVENCY EVENTS
If Kaffeina accepts this application, the Applicant may be approved for a business trading account. The granting of any credit facilities is at Kaffeina's sole discretion and may be approved, declined, varied, suspended or withdrawn at any time. All goods supplied and any credit provided are subject to Kaffeina's standard Terms and Conditions of Sale, which are incorporated into and form part of this agreement and govern all transactions between Kaffeina and the Applicant on an ongoing basis.
Date

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDateHourMinutesAM/PM Option
Signed by

First NameLast Name
Signature

- Sign with your mouse or your finger.
Please tick
Should be Empty:

Kaffeina Group Pty Ltd

Business Credit Information

Bank Contact Information

Business Trade References

Acknowledgement and Agreement