CUSTOMER APPLICATION (Consumer)

CUSTOMER APPLICATION (Consumer)
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. 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.

PERSONAL REFERENCES
Please list two personal references. By listing a reference you authorise us to contact them to verify your details.
Full Name
DOB
Mobile Phone
Email
example@example.com
Residential Address
Post Code
Full Name
DOB
Mobile Phone
Email
example@example.com
Residential Address
Post Code

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 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. I/We confirm and acknowledge the Company is not engaged in providing credit or is a credit service facility.
Full Name
Signature

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Date

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Date
Full Name
Signature

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Date

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Date
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PERSONAL REFERENCES