Credit Application Form - Coast2Coast Crane Trucks

Credit Application Form - Coast2Coast Crane Trucks

Credit Application Form
Authorized Contact Information
Contact Name*

First NameLast Name
Title/Position
Phone Number*

Area CodePhone Number
Email*
example@example.com
Business Information
ABN/ACN*
Registered Company Name*
Trading Name
NoYes
In Business Since :

DayMonthYear
Leave day as 01 if unknown
Principal Nature of Busines
Accounts Phone #

Area CodePhone Number
Accounts Email
example@example.com
Postal Address

Street Address

Street Address Line 2

CityState

Post Code
Sole TraderPartnershipLimited liabilityOther

Bank References
Bank Name
BSB #
Account #
Contact Person

First NameLast Name
Contact Person Phone Number

Area CodePhone Number
Bank Address

Street Address

Street Address Line 2

CityState

Post Code

Trade References

Minimum of three to be supplied
1st Trade Reference
1) Company Name
Contact Name

First NameLast Name
Phone Number

Area CodePhone Number
Account opened since

DayMonthYear
Date
Credit Limit
Average Monthly Spend
Address

Street Address

Street Address Line 2

CityState

Post Code
2nd Trade Reference
2) Company Name
Contact Name

First NameLast Name
Phone Number

Area CodePhone Number
Account opened since

DayMonthYear
Date
Credit Limit
Average Monthly Spend
Address

Street Address

Street Address Line 2

CityState

Post Code
3rd Trade Reference
3) Company Name
Contact Name

First NameLast Name
Phone Number

Area CodePhone Number
Account opened since

DayMonthYear
Date
Credit Limit
Average Monthly Spend
Address

Street Address

Street Address Line 2

CityState

Post Code

Financial Information
Company Total Assets
Annual Revenue
Amount of Credit Requested
YesNo
If so, describe
YesNo
If so, describe
Terms & Conditions

1.
Payment of your account, if this application is successful, must be made by the due date which will appear on each invoice. If any monies become overdue, the entire amount then outstanding shall become owing and the Company as your supplier shall be entitled to proceed to recover the whole debt.

2.
You must advise the Company in writing of any change in the business structure as shown in your application, whereupon a new application will be required to be submitted and accepted. Failing such notification or until replacement credit arrangements are properly in place, the applicant as named herein shall be and remain responsible for all charges payable or to become payable.

3.
Failure to observe either of the above terms or if any of the information provided is untrue, then credit facilities may be withdrawn and all charges made to your account will then become immediately due and payable.

4.
The company reserves the right to withdraw credit facilities at any time, whereupon the whole account will then become immediately due and payable.
Authorized Employee*

PrefixFirst NameLast Name
Company Name*
Employee Title*
Signature*

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