Kaffeina Group Credit Application

Kaffeina Group Pty Ltd

Commercial credit application
Credit Application

Kaffeina Group Pty Ltd
ABN 94 152 310 999

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

This form requests key business and financial information to enable Kaffeina Group Pty Ltd to:
- Assess your creditworthiness
- Determine appropriate credit limits and trading terms
- Establish and manage an ongoing trading relationship
All information provided will be treated as confidential and used solely for the purposes of credit assessment and ongoing account management.

Submission of this application does not guarantee approval. Any credit granted 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
YESNO
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
YESNO
Director 2 name*

First NameLast Name
Mobile Number Director 2*
Format: (0000) 000-000.
E-mail Director 2*
example@example.com
YESNO
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
YESNO
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.
I confirm that I am duly authorised to enter into this credit agreement on behalf of the Applicant and to bind the Applicant to its terms and conditions.
I certify that all information provided in this application is true, complete and correct.
I authorise Kaffeina to obtain commercial and/or consumer credit reports and to contact trade references for the purpose of assessing this application and reviewing the Applicant’s credit account from time to time.
I consent to Kaffeina collecting, using and disclosing my/our personal information, including obtaining and exchanging credit information with credit reporting bodies and other credit providers, for the purpose of assessing and managing the Applicant’s credit account, in accordance with the Privacy Act 1988.
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.
NO - I/We warrant that I/we are solvent within the meaning of section 95A of the Corporations Act 2001 and are able to pay my/our debts as and when they fall due. No Insolvency Event has occurred in relation to me/us. I/We will immediately notify Kaffeina in writing of any circumstance affecting my/our solvency.YES – I/We are presently, or have in the past been, subject to an insolvency event (including bankruptcy, liquidation, administration or receivership).
If Kaffeina accepts this application, I/we agree that all goods supplied and credit provided to the Applicant 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
DateHourMinutesAM/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