BLG Credit Application Form

Credit Application Form

ABN: 78438997209
I/We the undersigned hereby apply for a trading account with any supplier represented by The Brand Licensing Group.
I/We understand that additional account application forms may be required by individual suppliers and agree to complete these as requested.
Trading Name:*
ABN:*
Address:*

Street Address

Street Address Line 2

CityState

Postcode
Store Type:*
Website URL:
If applicable.
Shipping Address (if different from above):

Street Address

Street Address Line 2

CityState

Postcode
Contact Name:*

First NameLast Name
Contact Number:*
Format: (000) 000-0000.
Contact Email:*
Billing Details
Are you a member of a buying group?*

YesNo
If YES, please nominate group name for order & billing processing*
If no please type N/A.
Do you require an additional account for direct billing?

YesNo
Invoice/Accounts Email:
If different from above.
Owner of Trading Name:
(Purchaser)
Business Type:*

Sole TraderPartnershipPty Ltd CompanyLtd CompanyOther
Personal Details

(For Each Proprietor/Director/Partner)
Full Name (Person 1):

PrefixFirst NameMiddle NameLast Name
Residential Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
Mobile Number:
Date of Birth:

DayMonthYear
Driver's License Number:
Trade References
Business Name:
Enter trade reference 1.
Business Number
Please enter a valid phone number.Format: (000) 000-0000.
Business Name:
Enter trade reference 2
Business Number:
Please enter a valid phone numberFormat: (000) 000-0000.
Terms & Conditions
Ordering & Payment: 30 days Net or Prepayment for new accounts

Minimum Order: MOV $400 (ex GST)

Shipping: FIS for orders over $400 (ex GST); $20 shipping fee for rural and remote areas.
Returns & Defective Goods: Based on the provided terms, all credit claims must be made in writing via email. Goods can only be returned for credit if notification of the proposed return is received by the supplier within 7 days of the delivery date.

I/We have read and understood this document and have been given the opportunity to seek independent legal advice. In the case of a Purchaser that is an incorporated entity, the person(s) signing these terms and conditions warrant(s) that they are authorised to sign on behalf of the Purchaser and to legally bind the Purchaser.
Title/Position:*
Full Name:*
Signed (Person 1)*

Director/Owner
Date Signed:*

DayMonthYear
Date
Should be Empty: