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 (3) orders, then a 30-days term account can be requested in writing
You agree to the Magusto Wines Wholesale 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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