Credit Application

1. Company Details
Full Business Name
Registered Company Name
ABN
Established for
Street Address
Postal Address
2. Accounts Payable Contact
Name:
Position
Telephone Number
Fax Number
Email
3. Credit References
Please supply two trade references to support this credit application.
Reference 1
Company Name
Contact Name
Phone Number
Fax No.
Email Address
Reference 2
Company Name
Contact Name
Phone Number
Fax No.
Email Address
4. Payment Option
Please Note: All invoices, Credits, Statements & Notifications will be emailed to the email address specified on this form.
Please advise you method of payment (tick one)
- Cheque
- Electronic Fund Transfer (preferred method)
OUR EFT DETAILS ARE AS FOLLOWS
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: accounts@luckens.com.au
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.

Full name

Position

Signature

Print name (Electronic Signature)

Date

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CREDIT APPLICATION

1. Company Details

2. Accounts Payable Contact

3. Credit References

4. Payment Option

OUR EFT DETAILS ARE AS FOLLOWS

5. Authorisation