Credit Form

1. Sole Trader

Full Name (SURNAME)

given names

Date of Birth

Business Name

ABN

Address

unit

street number

street name

city / Suburb / Town

state

post code

contact

std

home

std

business / work

or mobile number

DRIVER’S LICENCE NUMBER

is home:

owned?
rented?

PLEASE SPECIFY AGENT’S NAME:

or 2. partnership

Business Name

ABN

Address

unit

street number

street name

city / Suburb / Town

state

post code

partner 1:

Full Name (SURNAME)

given names

Date of Birth

RESIDENTIAL ADDRESS

unit

street number

street name

city / Suburb / Town

state

post code

or mobile number

DRIVER’S LICENCE NUMBER

is home:

owned?
rented?

PLEASE SPECIFY AGENT’S NAME:

partner 2:

Full Name (SURNAME)

given names

Date of Birth

RESIDENTIAL ADDRESS

unit

street number

street name

city / Suburb / Town

state

post code

or mobile number

DRIVER’S LICENCE NUMBER

is home:

owned?
rented?

PLEASE SPECIFY AGENT’S NAME:

or 3. company or trust

COMPANY OR TRUSTEE NAME:

ABN

BUSINESS ADDRESS

unit

street number

street name

city / Suburb / Town

state

post code

or mobile number

DRIVER’S LICENCE NUMBER

is home:

owned?
rented?

PLEASE SPECIFY AGENT’S NAME:

director 1:

Full Name (SURNAME)

given names

Date of Birth

RESIDENTIAL ADDRESS

unit

street number

street name

city / Suburb / Town

state

post code

mobile number

DRIVER’S LICENCE NUMBER

is home:

owned?
rented?

PLEASE SPECIFY AGENT’S NAME:

director 2:

Full Name (SURNAME)

given names

Date of Birth

RESIDENTIAL ADDRESS

unit

street number

street name

city / Suburb / Town

state

post code

mobile number

DRIVER’S LICENCE NUMBER

is home:

owned?
rented?

PLEASE SPECIFY AGENT’S NAME:

SECTION B: BUSINESS PROFILE

Type of Business:

Year Business Commenced:

Annual Turnover: $

employees: number of employees

Are Business Premises:

owned?
rented?

PLEASE SPECIFY AGENT’S NAME:

SOLVENCY

Has the business had any judgments against it in the last 5 years or been served with a Statutory Demand?

yes
no

If Yes, please provide details:

Has any partner, director or principal

Been bankrupt?

yes
no

Entered an arrangement under the Bankruptcy Act?

yes
no

Had a judgment in the last 5 years?

yes
no

If Yes, please provide details:

SECTION C: MAJOR CUSTOMERS

1. NAME OF CUSTOMER

ANNUAL SALES TO CUSTOMERS ($)

2. NAME OF CUSTOMER

ANNUAL SALES TO CUSTOMERS ($)

3. NAME OF CUSTOMER

ANNUAL SALES TO CUSTOMERS ($)

SECTION D: REFERENCES

BUSINESS NAME

CONTACT NAME

PHONE NUMBER

BUSINESS NAME

CONTACT NAME

PHONE NUMBER

BUSINESS NAME

CONTACT NAME

PHONE NUMBER

accountant

name:

email:

telephone:

How long has your accountant acted for you? (Years)

bank

Name of Bank

Manager Mr/Mrs

Branch

How long have you banked at that branch? (Years)

telephone

TRADING TERMS

Payment in full is required within .......... days from date of invoice.
An Account Keeping Fee of $20.00 per month will be imposed on overdue Accounts.
In the event of the Customer being in default of his obligation to pay and the overdue account is then referred to a debt collection agency, and/or law firm for collection and the agency charges commission on a contingency basis the Customer shall be liable to pay as a liquidated debt, the commission payable by the Supplier to the agency, fixed at the rate charged by the agency from time to time as if the agency has achieved one hundred per cent recovery and the following formula shall apply.
In the event where the agency is Prushka Fast Debt Recovery the applicable commission rate for the amount unpaid is as detailed on www.prushka.com.au

In the event where the Supplier or the Supplier’s agency refers the overdue account to a lawyer the Customer shall also pay as a liquidated debt the charges reasonably made or claimed by the lawyer on the indemnity basis.
Overdue accounts will be subject to interest at the rate prescribed by the Penalty Interest Rates Act (Vic) plus 2%.Our goods and services come with guarantees that cannot be excluded under the Australian Consumer Law. For major failures with the service, you are entitled:
Our goods and services come with guarantees that cannot be excluded under the Australian Consumer Law. For major failures with the service, you are entitled:
- to cancel your service contract with us; and
- to a refund for the unused portion, or to compensation for its reduced value.
You are also entitled to choose a refund or replacement for major failures with goods. If a failure with the goods or a service does not amount to a major failure, you are entitled to have the failure rectified in a reasonable time. If this is not done you are entitled to a refund for the goods and to cancel the contract for the service and obtain a refund for any unused portion. You are also entitled to be compensated for any other reasonable foreseeable loss or damage from a failure in the goods or service.
Where more than one party is liable for payment of this account, they will be liable jointly and severally.
The Customer covenants that the information provided in this Application is true and correct.
Orders are subject to the terms and conditions notified to the Customer from time to time.
Property in any goods sold will not pass until payment for those goods is made in full. The Customer shall keep such goods separate and shall allow access to the Supplier to repossess such goods where this account is more than 30 days overdue of where the Customer goes into receivership, liquidation or administration.
Reference to an individual includes reference to his heirs and executors and reference to a company shall include its Receivers, Administrator and Liquidator.

Signed by (print full name)

on behalf of the Customer on (Date) DD/MM/YY

Position held:

DEED OF GUARANTEE AND INDEMNITY

I / We

of

(“the Guarantors”) in consideration of the within-named Supplier (“the Supplier”) providing credit to the within-named Customer (“the Customer”) at our request DO HEREBY for ourselves and respective executors and administrators jointly and severally covenant with the Supplier that if at any time default shall be made in the payment of any monies payable by the Customer to the Supplier we will forthwith on demand by the Supplier pay to it the whole of such monies which shall then be due and payable to the Supplier and will keep the Supplier indemnified against all losses costs charges and expenses whatsoever which the Supplier may incur by reason of any default on the part of the Customer in complying with the trading terms and conditions of the Supplier.

EXECUTED AS A DEED on the day of

SIGNED SEALED AND DELIVERED by the said Full name of Guarantor

in the presence of:

witness:

name of witness:

EXECUTED AS A DEED on the day of

SIGNED SEALED AND DELIVERED by the said Full name of Guarantor

in the presence of:

witness:

name of witness:

Account Application Form For Supply of Credit From (type in full name, address and ACN/ABN of your business entity here) ... (&supplier&)

^*Please complete one of 1, 2 or 3 of Part A.

PART A – ENTITY

Has the business had any judgments against it in the last 5 years or been served with a Statutory Demand?

Been bankrupt?

Entered an arrangement under the Bankruptcy Act?

Had a judgment in the last 5 years?

DEED OF GUARANTEE AND INDEMNITY