Open a Roey Bottleshop Account
Apply for a business or event account to access weekly deals, easy ordering and a wide range of beer, wine and spirits.
ABN: 99 009 281 163 ACN: 009 281 163
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Business Details
Business/Trading Name
*
Registered Company Name (if applicable)
ABN
*
Corporate Structure
*
Please Select
PTY LTD
Public Company
Incorporated Body
Trustee
Sole Trader
Partnership
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Accounts Details
Accounts Payable Contact
*
First Name
Last Name
Accounts Payable Email
*
example@example.com
Accounts Payable Mobile
*
Please enter a valid phone number.
Format: 0000 000 000.
Billing Address
*
Street Address
City
State
Post Code
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Ordering Details
Site Contact
*
First Name
Last Name
Site Contact Mobile Number
*
Please enter a valid phone number.
Format: 0000 000 000.
Delivery Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Ordering Email Address
*
example@example.com
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Financial & Credit Terms
Business Premiss
*
Please Select
Owned
Leased
Date Business Commenced
*
/
Day
/
Month
Year
Date
Bank
*
Branch
*
Type Of Acocunt
*
Please Select
Credit
COD
Credit Terms
*
Please Select
7 Day (from invoice)
Other - by written approval
COD
Monthly Credit Applied For
*
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References & Director Details
Reference Company 1
*
Reference Company 1 Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Reference Company 2
*
Reference Company 2 Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Reference Company 3
Reference Company 3 Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Director/Owner Name
*
First Name
Last Name
Director/Owner Address
*
Street Address
Street Address Line 2
Suburb
State / Province
Post Code
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Terms & Conditions
Full Name Of Signee
First Name
Last Name
Signature
*
Date
/
Day
/
Month
Year
Date
Hour Minutes
AM
PM
AM/PM Option
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