More Than Coffee - coffee, tea, office supplies, stationery

CREDIT APPLICATION FORM

Account Name

Person/Company/Business:

Australian Business Number (ABN):

Address Details

Delivery Address:

Postal Address:

E-mail Address:

Phone Numbers

Contact Name for Orders:

Phone No:

Facsimile:

Add Mobile Number here:

About Your Business

Type of Business:

Length of Operation:

No of staff at location:

Approximate monthly credit requried:

Bank Name:

Branch:

Full Names and Home Address of Proprietors:

REFERENCES:
Please provide names, address and phone numbers of main suppliers to whom reference can be made:

1.	Phone:
2.	Phone:
3.	Phone:

CREDIT TERMS:
1. Payment of the account is to be made 21 days from invoice date.
2. Credit facilities may be withdrawn on overdue accounts at the company's discretion without notice.

I HEREBY ACKNOWLEDGE THAT MORE THAN COFFEE PTY LTD, REMAIN THE OWNER OF THE GOODS SUPPLIED UNTIL PAID FOR IN FULL, AND THAT I UNDETAKE TO ADHERE TO THE ABOVE TERMS.

............................................
Applicant's Name

............................................
Applicant's Signature

............................................
Date

Fax to 08 82627968 or Post to Unit9/28 Maxwell Rd, Para Hills SA 5096

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