Form: Credit Application

Credit Account Application

Personal/Directors Guarantee and Indemnity:

First Name

Middle Name

Last Name

Trading Name (if different from above)

Physical Address

Address Line 1

Address Line 2

City

State

Post Code

Country

Is your billing address the same as your physical address?

Yes

Billing Address

Address Line 1

Address Line 2

City

State

Post Code

Country

Mobile

Phone

Personal Details:

Date of birth

Driver's Licence No

Business Details:

ABN/ACN

Date Established (current owners)

Nature of Business

Paid Up Capital: $

Estimated Monthly Purchases: $

Credit Limit Required: $

Principal Place of Business is:

Rented

Owned

Mortgaged

Who is the mortgage with?

How many Directors / Owners / Trustee are to be listed on the account

1 Person

2 People

3 People

Directors / Owners / Trustee 1 Details:

First Name

Middle Name

Last Name

Director Identification No

Private Address

Address Line 1

Address Line 2

City

State

Post Code

Country

Date of Birth

Driver's Licence No

Mobile

Phone

Directors / Owners / Trustee 2 Details:

First Name

Middle Name

Last Name

Director Identification No

Private Address:

Address Line 1

Address Line 2

City

State

Post Code

Country

Date of Birth

Driver's Licence No

Mobile

Phone

Directors / Owners / Trustee 3 Details:

First Name

Middle Name

Last Name

Director Identification No

Private Address

Address Line 1

Address Line 2

City

State

Post Code

Country

Date of Birth

Driver's Licence No:

Mobile

Phone

Payment Terms:

Payment terms

5 Days following month after statement

30 Days after invoice date

COD

Other

Purchase Order Required?

Yes

Accounts Email

Accounts to be contacted?

Yes

Accounts Contact - First Name

Last Name

Accounts Contact - Phone/Mobile

Trade References:

Trade Reference 1 - First Name

Last Name

Trade Reference 1 - Company Name:

Trade Reference 1 - Email

Trade Reference 1 - Mobile

Trade Reference 2 - First Name

Last Name

Trade Reference 2 - Company Name

Trade Reference 2 - Email

Trade Reference 2 - Mobile

Trade Reference 3 - First Name

Last Name

Trade Reference 3 - Company Name

Trade Reference 3 - Email

Trade Reference 3 - Mobile

I certify that the above information is true and correct and that I am authorised to make this application for credit. I have read and understand the Terms of Trade of Builders Trading Co-Operative Limited which form part of and are intended to
be read in conjunction with this Credit Account Application and agree to be bound by these conditions. I authorise the use of my personal information as detailed in the Privacy Act clause therein.

Signature

Sign Here

Signed By: First Name

Last Name

Position/Title

Date

Personal/Directors Guarantee and Indemnity:

For all credit accounts, a Personal Guarantee is required to close out your account application.

Action Required:
1. Click here to download the Personal/Directors Guarantee and Imdemnity Form (strongly recommend opening in a new tab)
2. Print the page, fill in the details, and have the Director(s) sign it alongside an independent adult witness.
3. Snap a clear photo or scan the signed page with your smartphone and upload it below.

File Upload

Choose File

Credit Account Application.

Personal/Directors Guarantee and Indemnity:

Personal Details:

Business Details:

Directors / Owners / Trustee 1 Details:

Directors / Owners / Trustee 2 Details:

Directors / Owners / Trustee 3 Details:

Payment Terms:

Trade References:

Personal/Directors Guarantee and Indemnity:

Our services

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