MCL Customer Application Form

1
Company Name* This field is required.Enter the full legal name of your company.
2
Trading NameEnter the name under which your company trades if different from the registered name.
3
Business Address* This field is required.Enter your Business Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
4
Type of Company* This field is required.
Limited Liability
Please Select
Limited Liability
Partnership
Sole Trader
Other
5
GST Number
6
Director's Name* This field is required.Please provide the details of a director in your business.
First Name
Last Name
7
Primary Contact Name* This field is required.Please provide the details of the primary contact person of this account
First Name
Last Name
8
Primary Contact Phone Number* This field is required.Please provide the details of the primary contact person of this account
Area Code
Phone Number
9
Primary Contact Position* This field is required.Please provide the job title of the primary contact.
10
Accounts Payable Contact Name* This field is required.
First Name
Last Name
11
Accounts Payable Phone Number* This field is required.Please provide contact details for Accounts Payable
Area Code
Phone Number
12
Accounts Payable Email Address* This field is required.Please provide an email address for Invoices and Statements
example@example.com
13
Trade Reference #1 Name* This field is required.
14
Trade Reference #1 Phone Number* This field is required.
Area Code
Phone Number
15
Trade Reference #2 Name* This field is required.
16
Trade Reference #2 Phone Number* This field is required.
Area Code
Phone Number
17
Appropriate Warranties and Personal Guarantee* This field is required.Declaration I/We hereby declare that the information provided in this application is true and correct to the best of my/our knowledge. I/We understand that the information provided will be used to assess our application for credit with MCL (2017) Limited. Authorisation: I/We authorise MCL (2017) Limited to contact the trade references provided and to obtain credit information from credit reporting agencies as part of the assessment process. Warranties: I/We warrant that I/we have the authority to make this application on behalf of the company. I/We warrant that the company is solvent and able to pay its debts as and when they fall due. Personal Guarantee: In consideration of MCL (2017) Limited agreeing to provide goods/services on credit to the applicant, I/we, the undersigned, being the authorised signatory(ies) of the applicant, hereby jointly and severally guarantee to MCL (2017) Limited the due and punctual payment of all amounts which shall be due and payable by the applicant to MCL Packaging (2017) Limited. This guarantee shall be a continuing guarantee and shall remain in force until all amounts owed by the applicant to MCL Packaging (2017) Limited have been paid in full. Debt Collection Fees: I/We acknowledge and agree that, in the event of any overdue accounts, all costs incurred by MCL Packaging (2017) Limited in the collection of such overdue accounts, including but not limited to debt collection agency fees and legal fees, will be borne by us (the debtor). We accept responsibility for these costs and agree to indemnify MCL (2017) Limited for any expenses incurred in the process of debt recovery.
Please Select
Please Select
Agree
Disagree
18
Signatory Name* This field is required.Please print your name below.
First Name
Last Name
19
Signatory Position* This field is required.Please print your position in the company below.
20
Signature* This field is required.Signatory Information: By signing below, I/we acknowledge that I/we have read, understood, and agree to the terms and conditions in this application form.
Powered by Jotform SignClear
21
Date* This field is required.
Date
Day
Month
Year
Should be Empty: