|
CREDIT APPLICATION
|
|
|
|
|
|
Company Name *
|
|
*
|
ABN
*
|
|
*
Invalid ABN number.
|
|
Trading Name
*
|
|
|
ACN
|
|
|
|
No of Employees
|
|
Business Type
*
|
*
|
|
POSTAL ADDRESS
|
|
Address *
|
|
*
|
|
Suburb
*
|
*
|
State
*
|
*
|
Postcode
*
|
*
Please enter numbers.
|
|
Email
*
|
*
Invalid email address.
|
Phone
*
|
*
Invalid postal phone number.
|
Fax
|
|
|
|
|
|
|
|
|
|
Accounts Contact
*
|
*
|
|
Email
*
|
*
Invalid email address.
|
Phone
*
|
*
Invalid account phone number.
|
Fax
|
*
|
|
|
|
DIRECTORS/PROPRIETORS
|
|
1
|
|
Please specify your role
*
|
*
|
Driver License No
*
|
*
|
|
Title
*
|
*
|
First Name
*
|
*
|
Surname
*
|
*
|
|
|
|
Address
*
|
*
|
|
Suburb
*
|
*
|
State
*
|
*
|
Postcode
*
|
*
Please enter numbers.
|
|
Email
*
|
*
Invalid email address.
|
Phone
*
|
*
Invalid phone number.
|
Fax
|
|
|
Is this Property:
*
|
*
|
|
|
2
|
|
Please specify your role
|
|
Driver License No
|
|
|
Title
|
|
First Name
|
|
Surname
|
|
|
|
|
Address
|
|
|
Suburb
|
|
State
|
|
Postcode
|
Please enter numbers.
|
|
Email
|
Invalid email address.
|
Phone
|
Invalid phone number.
|
Fax
|
|
|
Is this Property:
|
|
|
|
|
Has the applicant or any of its Directors or Partners been previously or currently
Declared Bankrupt, and if YES, provide details of the name, date of bankruptcy and
date discharge from bankruptcy.
|
|
Is YES, give details below:
*
|
*
|
|
|
|
|
|
TRADE REFERENCES
|
|
Amount purchased from referee in last 12 months:
*
|
*
|
|
Company Name
*
|
*
|
|
Address
*
|
*
|
|
Suburb
*
|
*
|
State
*
|
*
|
Postcode
*
|
*
Please enter numbers.
|
|
Email
*
|
*
Invalid email address.
|
Phone
*
|
*
Invalid phone number.
|
Fax
|
|
|
|
|
Amount purchased from referee in last 12 months:
*
|
*
|
|
Company Name
*
|
*
|
|
Address
*
|
*
|
|
Suburb
*
|
*
|
State
*
|
*
|
Postcode
*
|
*
Please enter numbers.
|
|
Email
*
|
*
Invalid email address.
|
Phone
*
|
*
Invalid phone number.
|
Fax
|
|
|
|
|
JOINT AND SEVERAL GUARANTEE AND AGREEMENT TO CREDIT REPORT
|
In consideration of GDR Marketing & Distribution Pty Ltd (herein after called “GDR”)
agreeing at my/our request to supply goods and services. I/we jointly and severally
guarantee to GDR the prompt payment of any monies owing to GDR. This guarantee shall
be a continuing guarantee and should not be affected by GDR granting time or other
arrangement to the Applicant of this credit application. I/we shall be deemed to
be principal debtor to GDR in the event the Applicant fails to pay GDR Group for
all or any of the monies payable.
We agree that GDR Marketing & Distribution Pty Ltd may give to and seek from any
credit providers that may be named in a credit report issued by a credit reporting
agency, information about my/our credit arrangements. I/we understand that this
information can include any information about my/our credit worthiness, credit standing,
credit history or credit capacity that credit providers are allowed to give or receive
from each other under the Privacy Act.
|
|
|
|
Applicant Name
*
|
*
|
Position
*
|
*
|
Date Signed
|
|
|
|
|
|
|
|
|
|
Applicant Name
|
|
Position
|
|
Date Signed
|
|
|
|
|
Credit Limit Requested:
|
|
|
Credit Terms Agreed:
|
|
|
|
Trading Terms Agreed:
*
|
*
|
|
|
|
|
|
|
GDR Marketing & Distribution Pty Ltd
Level 2, 72 Campbell Street Surry Hills,
NSW, 2010
ABN 76 003 869 903
|
(02) 9695 0500
(02) 9114 9941
inquiries@gdrgroup.com.au
www.gdrgroup.com.au
|