Registered Business Name:
Registered Business Address: Postcode:
Type of Business: Sole Trader Company Pty/Ltd Partnership .
Business Trading Name:
Business ABN:
Business Trading Address: Postcode:
Business Postal Address: Postcode:
Telephone Number: Fax Number: Mobile:
Name of Person in Charge of Accounts:
Email:
Name and Addresses of Director/s
Name: Address:
Has Proprietor/any of the Partners ever been registered under any part of the bankruptcy act, or
been under any special financial arrangements: Yes No .
If yes, please supply particulars:
Date Business commenced: Nature of Business:
Bank: Branch:
Trade References
Name: Contact: Telephone:
Anticipated monthly purchases:
Position: Name: Date:
Terms of Payment strictly 30 Days
