Wholesale Application
Registered Business Name
*
Trading Name
*
Business Structure
*
Please Select
Company
Partnership
Sole Trader
Other
Nature of your business
Please Select
Restaurant
Retail
Bar
Online
Other
ACN
*
ABN
*
Liquor License Number
*
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Delivery Information
Business Delivery Address
*
Street Address
Street Address Line 2
City
State
Post Code
Delivery Instructions
*
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Purchaser & Accounts
Purchasers Name
First Name
Last Name
Purchaser Email
example@example.com
Purchaser Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Accounts Payable Name
First Name
Last Name
Accounts Payable Email
example@example.com
Accounts Payable Phone
Please enter a valid phone number.
Format: (000) 000-0000.
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Directors Details
Directors Name
First Name
Last Name
Directors Email
example@example.com
Directors Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Directors Address
Street Address
Street Address Line 2
City
State
Post Code
Drivers License Number
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Business References
Reference 1: Company Name
*
Contact Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
E-mail
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State
Post Code
Reference 2: Company Name
Contact Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
E-mail
example@example.com
Address 2
Street Address
Street Address Line 2
City
State
Post Code
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Wholesale Account Agreement
Wholesale Account Agreement Terms
*
All invoices are to be paid in advance for the first three orders, then 30 days terms can be requested.
Abide by Magusto Wines wholesale account terms and conditions
Claims Terms
*
Any claims arising from invoices must be made in writing within 7 business days of the invoice date.
Agreement and Terms
*
By submitting this credit application, you authorise us to make inquires into the buisness references you have provided.
Enter the word as it's shown
*
Signature
Submit
Submit
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