PLEASE ENSURE ALL SECTIONS ARE COMPLETED!

TRADING NAME		DATE:
PARTNERS NAMES
HOME ADDRESS		PHONE:
COMPANY NAME		ABN:
DIRECTORS NAMES
HOME ADDRESS		PHONE:
BUSINESS POSTAL ADDRESS
BUSINESS DELIVERY ADDRESS
PHONE NUMBER:		FAX NUMBER:
PERSON TO CONTACT REGARDING ACCOUNTS:
BANK:		BRANCH:
ACCOUNT NAME ON CHEQUES:
EMAIL ADDRESS:

TRADE REFERENCES: (This section must be completed)

1.		PHONE:		FAX:
2.		PHONE:		FAX:
3.		PHONE:		FAX:

Full payment of the statement balance is required no later than the thirtieth day of the following month. Credit is only available on stationery and sundry items and not on equipment purchases or service/repair work without prior arrangement. Failure to abide by our terms may incur termination of credit without notice.

Ownership of goods supplied does not pass to purchaser until payment has been received in full.

I/We agree to abide by the terms of this account.

SIGNED		NAME
POSITION
FOR AND BEHALF OF: