CREDIT APPLICATION FORM

Date: [DD/MM/YYYY]

SECTION 1: APPLICANT DETAILS

Type of Applicant: [ ] Sole Trader [ ] Partnership [ ] Company [ ] Trust

Business Name: [Enter Business Name]

Trading Name (if different): [Enter Trading Name]

ACN / ABN: [Enter ACN or ABN]

Registered Office Address: [Street Address] [City, State, Postcode]

Postal Address (if different): [Street Address] [City, State, Postcode]

Phone Number: [Enter Phone Number]

Email Address: [Enter Email Address]

Website: [Enter Website URL]

SECTION 2: BUSINESS CONTACTS

Primary Contact Name: [Enter Full Name]

Position: [Enter Job Title]

Phone: [Enter Direct Phone]

Mobile: [Enter Mobile]

Email: [Enter Email]

Accounts Payable Contact Name: [Enter Full Name]

Accounts Payable Email: [Enter Email Address for Invoices]

SECTION 3: TRADE REFERENCES

Please list two other suppliers who we may contact for a credit reference.

Reference 1: Company Name: [Enter Company Name] Contact Name: [Enter Name] Phone Number: [Enter Phone]

Reference 2: Company Name: [Enter Company Name] Contact Name: [Enter Name] Phone Number: [Enter Phone]

SECTION 4: CREDIT REQUEST

Requested Credit Limit: $[Enter Amount, e.g., 5,000.00]

Preferred Payment Terms: [ ] 7 Days [ ] 14 Days [ ] 30 Days [ ] Other (specify): [Enter Terms]

SECTION 5: DIRECTOR GUARANTEE

(If applicant is a Company, the Director(s) must complete this section)

In consideration of [Your Business Name] ("the Creditor") agreeing to extend credit to the Applicant at our request, we the undersigned Director(s) of the Applicant jointly and severally guarantee to the Creditor the due and punctual payment of all moneys owing by the Applicant to the Creditor and the performance and observance by the Applicant of its obligations under the Terms of Trade.

Director 1 Name: [Enter Full Name] Signature: ___________________ Date: [DD/MM/YYYY]

Director 2 Name: [Enter Full Name] Signature: ___________________ Date: [DD/MM/YYYY]

SECTION 6: AUTHORITY AND ACCEPTANCE

By signing below, the Applicant:

1. Applies for a credit account with [Your Business Name] ("the Supplier").
2. Agrees to be bound by the Supplier's current Terms of Trade, which are available on our website or attached hereto.
3. Acknowledges that the Supplier may conduct a credit check and obtain references.
4. Acknowledges that the Supplier retains title to all goods supplied until full payment is received (Retention of Title).
5. Agrees to pay interest on overdue accounts at the rate of [Enter Percentage]% per annum.
6. Agrees to indemnify the Supplier for all debt collection costs incurred if this account is placed in the hands of a debt collection agency.

Name of Authorized Signatory: [Print Name]

Position: [Enter Position]

Signature: ___________________

Date: [DD/MM/YYYY]

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For Office Use Only: [ ] Approved [ ] Declined [ ] Approved with conditions: [Notes]

Credit Limit Approved: $____________

Approved By: [Name]