• 1. Company Details

  • 2. Accounts Payable Contact

  • 3. Credit References

    Please supply two trade references to support this credit application.
  • Reference 1
  • Reference 2
  • 4. Payment Option

    Please Note: All invoices, Credits, Statements & Notifications will be emailed to the email address specified on this form.

    Bank: National Australia Bank
    Branch: Booragoon
    BSB: 086-136
    Account Number: 13158 - 7585
    Account Name: Citywalk Pty Ltd T/As Luckens Fumigation Services
    Contact Person/s: Jan Fletcher, Vanessa Taylor-Rennie or Denise Luckens
    Contact Email:
  • 5. Authorisation

  • 1. The Applicant hereby applies for credit with Citywalk Pty Ltd T/As Luckens Fumigation Services on the basis of the information supplied above. The Applicant certifies this information is true and correct.
  • 2. The Applicant authorises Citywalk Pty Ltd T/As Luckens Fumigation Services, for the purpose of this application, to collect and retain information about the Applicant and to enquire of all persons referred to in the above application regarding the contents of this application.
  • 3. The Applicant confirms that the person signing this application is duly authorised to sign on behalf of the Applicant.
  • 4. The Applicant, by signing this form, is agreeing to abide by our terms (which is clearly stated on all Company invoices & statements) of "STRICTLY 30 DAYS" and will endeavour to pay all accounts promptly on time. If the terms are defaulted, the account will become a cash only account. Credit will be reinstated at our discretion.
  • Print name (Electronic Signature)
  • Credit Application