NEW CLIENT APPLICATION

APPLICANT INFORMATION

Business Name:

Trading Name:

Entity Type:

Sole Trader

Partnership

Company

Business Address:

City:

State:

Post Code:

Postal Address:

City:

State:

Post Code:

Phone:

Fax:

Email:

Premises:

Rented

Owned

Credit Amount:

ABN:

Type of Business:

Contact Name for Accounts:

Contact Number for Accounts:

Contact Email for Accounts:

Contact Name for Purchases:

Contact Number for Purchases:

Contact Email for Purchases:

Send Invoice to above postal address?

Yes

Do you require a monthly statement?

Yes

Purchase Order Numbers required:

Yes

Payment Method Preference:

Cheque

Credit Card

Direct Deposit

TRADE REFERENCES

Trade Reference 1

Business Name:

Contact:

Phone:

Trade Reference 2

Business Name:

Contact:

Phone:

TERMS OF PAYMENT

1. We agree that monies due shall be paid within seven (7) days of receipt of an invoice.
2. We acknowledge accounts overdue by fourteen (14) days may incur a 15% administration fee. Should Quoject Pty Ltd incur any costs associated with collection, such as legal fees and/or collection agency fees etc., we agree to indemnify Quoject Pty Ltd for all such costs.
3. We agree that all goods and services will remain the property of Quoject Pty Ltd until paid in full.
4. We acknowledge submission of this Client Credit Application Form to Quoject Pty Ltd is deemed as acceptance of Terms of Payment stated.

Company Representative Name:

Company Representative Title:

Dated This Date/Time:

THIS IS STRICTLY A SEVEN (7) DAY ACCOUNT

NOTE: Submission of this credit application will be deemed as acceptance of the Terms and Conditions outlined above.

NEW CLIENT APPLICATION

We value your privacy as much as you do. We will not give your email address out to any other parties