Steelmark Customer Account Application Form

Customer Account Application Form

Please be advised that the review process may take up to two (2) weeks, as your submission undergoes both internal and external review.
What is your company type / business structure?*

Sole TraderPartnershipProprietary Limited (Pty Ltd)GovernmentPublicly Listed Company
Role
Date Today

DayMonthYear
Date

Section C: Credit Behavior & Risk
6. Estimated monthly spend with us?*

Less than $1,000$1,000 – $3,000$3,000 – $5,000$5,000 – $10,000
7. What credit limit are you applying for?*

$1,000$3,000$5,000$10,000

Trade References

To help us assess your application, please provide details for three current suppliers.
1. Registered Trading Name*
Trade reference business name (as registered with ASIC)
Contact Name*
Primary contact at the trade reference
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Position
Role or job title of the contact person
Monthly Spend
Average monthly spend with this supplier
CONSENT AND AUTHORITY TO DISCLOSE FINANCIAL AND CREDIT HISTORY

To whom it may concern,

I, {roleFullName}, hereby authorise {tradeReference1} to disclose and discuss our financial and credit history with Steelmark (Aust) Pty Ltd for the purpose of assessing our credit application.

This authority is given freely and remains valid for this application unless revoked in writing.
Signature*

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Signed:
{roleFullName}
{roleHidden}
{registeredTradingName}
{dateToday}

2. Registered Trading Name*
Trade reference business name (as registered with ASIC)
Contact Name*
Primary contact at the trade reference
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Position
Role or job title of the contact person
Monthly Spend
Average monthly spend with this supplier
CONSENT AND AUTHORITY TO DISCLOSE FINANCIAL AND CREDIT HISTORY

To whom it may concern,

I, {roleFullName}, hereby authorise {tradeReference2} to disclose and discuss our financial and credit history with Steelmark (Aust) Pty Ltd for the purpose of assessing our credit application.

This authority is given freely and remains valid for this application unless revoked in writing.
Signature*

Powered by Jotform SignClear
Signed:
{roleFullName}
{roleHidden}
{registeredTradingName}
{dateToday}

3. Registered Trading Name*
Trade reference business name (as registered with ASIC)
Contact Name*
Primary contact at the trade reference
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Position
Role or job title of the contact person
Monthly Spend
Average monthly spend with this supplier
CONSENT AND AUTHORITY TO DISCLOSE FINANCIAL AND CREDIT HISTORY

To whom it may concern,

I, {roleFullName}, hereby authorise {tradeReference3} to disclose and discuss our financial and credit history with Steelmark (Aust) Pty Ltd for the purpose of assessing our credit application.

This authority is given freely and remains valid for this application unless revoked in writing.
Signature*

Powered by Jotform SignClear
Signed:
{roleFullName}
{roleHidden}
{registeredTradingName}
{dateToday}

1. How long has your company been operating?	{a1}
2. Number of full-time employees?	{a2}
3. What is your company’s approximate annual revenue?	{b3}
4. What payment terms do you usually have with other suppliers?	{b4}
5. Does the company have any current credit defaults or court judgements?	{b5}
6. Estimated monthly spend with us?	{c6}
7. What credit limit are you applying for?	{c7}
8. How long have you been operating at your current location?	{d8}
9. What is the current status of your business premises?	{d9}
10. Has the company experienced financial restructuring in the last 3 years?	{d10}

Customer Acknowledgement

I, {roleFullName}, the undersigned hereby acknowledge that all purchases from Steelmark will be made pursuant to the Terms & Conditions attached to this application form which exclude and supersede any prior arrangements or any representation, warranty, assurance or undertaking given for or on behalf of Steelmark unless expressly accepted by an authorized office of Steelmark in writing.
Signature*

Powered by Jotform SignClear
Signed:
{roleFullName}
{roleHidden}
{registeredTradingName}
{dateToday}
Important Advisory:
Consistent with the acknowledgement above, all information provided in this form may be subject to verification, including contacting listed suppliers, ASIC, and other relevant sources as required.
Should be Empty:

Customer Account Application Form