Customer Application (Business)

Customer Application ( Business)
JC TEC SOLUTIONS PTY LTD ABN 35 683 080 677 (the Company) and (the Customer) as named below understand this is a contract and the document comprises the application and the Company's terms and conditions attached to it. This application may include a guarantee/s which must be completed in full in order to process this application. If you sign these documents OR order Goods or services OR retain Goods previously provided by the Company, after receiving these documents you will be bound by its terms. You should read the terms of these documents carefully and seek legal advice about its terms.

CREDIT DETAILS
ALL accounts are strictly 7 days from date of Invoice

Persons to contact regarding payment of the account:
Person 1 Name*

First NameLast Name
Position*
Email*
example@example.com
Mobile Phone Number*
Please enter a valid phone number.
Person 2 Name

First NameLast Name
Position
Email
example@example.com
Mobile Phone Number
Please enter a valid phone number.

TRADE REFERENCES
Can you Provide Trade References?

YesNo
Please list three trade references which you have a credit account with. By listing a reference you authorise us to contact them to discuss your trading history and to verify your details.
Business Name
Trading Address
Contact Name
Phone Number
Email
Date Started Trading

DayMonthYear
Date
Business Name
Trading Address
Contact Name
Number
Email
Date Started Trading

DayMonthYear
Date
Business Name
Trading Address
Contact Name
Number
Email
Date

DayMonthYear
Date

Sole Trader / Partnership
Sole Trader / Partnership (Business is not incorporated and does not have an ACN)
Registered Business No*
Original State of registration*
Personal details of all registered proprietors of the trading name: (if more than 2 please attach details of extra proprietors)
Name*

First NameMiddle NameLast Name
Phone*
Address*
Post Code*
DOB*

DayMonthYear
Date
Drivers License Number*
Original State of registration*
Name

First NameMiddle NameLast Name
Phone
Address
Post Code
DOB

DayMonthYear
Date
Drivers License Number
Original State of registration
All details above are true and to the best of my knowledge

Yes

Company / Incorporated Association
Company / Incorporated Association If a personal / director guarantee is required, these should be included with this form and must be signed by all directors of the company

Ltd (Limited - Public Company)
ACN*
Date of Incorporation

DayMonthYear
Date
Type*

Pty Ltd (Proprietary Limited)Ltd (Limited – Public Company)Incorporated Association
Original State of registration*
Personal details of all registered proprietors of the trading name: (if more than 2 please attach details of extra proprietors)
Name*

First NameMiddle NameLast Name
Phone*
Address*
Post Code*
DOB*

DayMonthYear
Date
Drivers License Number*
Original State of registration*
Name

First NameMiddle NameLast Name
Phone
Address
Post Code
DOB

DayMonthYear
Date
Drivers License Number
Original State of registration
All details above are true and to the best of my knowledge

Yes

DECLARATION
1. The Customer and each of the Guarantors have received a complete and legible copy of this Agreement and Terms and Conditions before signing it.
2. I/We confirm we have read, understand and agree to be bound by the Terms and Conditions of Trade as set out in the following pages.
3. I/We declare and warrant that the applicant/s are neither bankrupt nor insolvent and have not committed any act of bankruptcy nor traded whilst insolvent within the previous 3 years.
4. I/We confirm and acknowledge for the purposes of section 13 National Consumer Credit Code ("Code"), as having made this declaration before entering into this Agreement that the credit (if any) which is to be provided is to be applied wholly or predominantly for a purpose that is not a Code purpose.
5. I acknowledge and warrant that I am duly authorised to sign and make this application.
Full Name*
Signature*

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Date*

DayMonthYear
Date
Full Name
Signature

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Date

DayMonthYear
Date
Should be Empty:

Customer Application ( Business)