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ABN: 68 151 677 431

4 Normanby St Warragul VIC 3820 Ph: 03 5623 6749 Fax: 03 5623 6336

Email: kate@blackwoodsrm.com.au

TRADE CREDIT APPLICATION

Customer Trading Details

Entity Name *

Trading Name Different *

YesNo

Trading Name *

ABN *

Business Structure *

Nature of Business *

Trustee/Company ACN *

Trading Address *

Postal Address (if different)

Suburb *

Postal Suburb

State *

Postcode *

Postal State

Postal Postcode

Phone Number *

Email Address for Accounts Payable/Statements *

Send code

Do you have a different address for invoices *

YesNo

Email Address for Invoices *

Name of Principal Contact *

Title *

Mobile Phone Number *

Email *

Customer Owner/Director Details

1

Name *

Date of Birth *

Home Address *

Ówned or Rented *

OwnedRented

Driver's Licence No *

Business Information

How long in business? *

Registered: *

Name of Bank: *

Branch: *

Account Number: *

What will you be purchasing? *

ConcreteGarden SuppliesBulk Rock

Expected Ave Monthly Spend *

Amount of Credit Sought: *

Purchase Orders Required? *

YesNo

Please Provide Purchase Order Requirements:

Trade References (4 references with at least 2 Major Suppliers with similar spend to credit sought)

1 - Bunnings, Holcim, Reece, Dahlsen's and Boral will not provide references, please do NOT provide them.

Company Name *

Phone *

Contact Person

Email Address *

2

Company Name *

Phone *

Contact Person

Email Address *

3

Company Name *

Phone *

Contact Person

Email Address *

4

Company Name *

Phone *

Contact Person

Email Address *

ACCEPTANCE OF ACCOUNT TERMS & CONDITIONS

Please follow the link to read the Account Terms & Conditions.

https://blackwoodsreadymixed.com.au/wp-content/uploads/2022/05/Terms-Conditions-Blackwoods.pdf

I have read, understand and accept the Account Terms & Conditions *

Yes

Signature *

Draw signature|Type signatureClear

Name of Authorised Representative *

Date *

Deed of Guarantee

https://blackwoodsreadymixed.com.au/wp-content/uploads/2022/05/Deed-of-Guarantee-and-Indemnity.pdf

Customer Trading Details

Customer Owner/Director Details

Business Information

Trade References (4 references with at least 2 Major Suppliers with similar spend to credit sought)

ACCEPTANCE OF ACCOUNT TERMS & CONDITIONS

Deed of Guarantee

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