Kaffeina Group Credit Application

Kaffeina Group Pty Ltd - also trading as Ublend, The Little Guy Espresso and 36th Parallel Coffee

Commercial credit application
This Credit Application Form allows you to apply for a trade account with Kaffeina Group Pty Ltd. (Kaffeina), owner and operator of 36th Parallel Coffee, Ublend (Your Coffee, Your Brand!) and The Little Guy Espresso.

It requests key business and financial information so we can properly assess your application, determine appropriate credit terms, and establish a clear and structured trading relationship.

All information provided will be treated confidentially and used solely for credit assessment and ongoing account management purposes.

Submission of this form does not guarantee approval, and any credit granted will be subject to our Terms and Conditions of Sale.
Business structure*
Full legal name (Applicant)*
Your company name
Is Trading name different ?*

YESNO
Trading name*
Your company name
ABN*
Address*

Street Address

Street Address Line 2

CityState

Post CodeCountry
Type of business*
Phone Number*
Directors name*

First NameLast Name
Directors Mobile Number*
Directors E-mail*
example@example.com
Add another Director ?

YESNO
Director 2 name*

First NameLast Name
Mobile Number Director 2*
E-mail Director 2*
example@example.com
Add another Director ?

YESNO
Director 3 name

First NameLast Name
Mobile Number Director 3*
E-mail Director 3*
example@example.com

Business Credit Information

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

YESNO
Accounts Payable Contact*

First NameLast Name
Accounts Payable Phone*
Accounts Payable Mobile Phone
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*

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*
Mobile Number
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*
Mobile Number 2
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*

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.
APPLICATION IS COMPLETE AND CORRECT.*

I certify that all information provided in this application is true, complete and correct.
CREDIT REPORTS AND TRADE REFERENCES*

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.
PRIVACY AND CREDIT INFORMATION CONSENT*

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.
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*

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*

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

Kaffeina Group Pty Ltd - also trading as Ublend, The Little Guy Espresso and 36th Parallel Coffee

Business Credit Information

Bank Contact Information

Business Trade References

Acknowledgement and Agreement