Business Credit Application

APPLICANT INFORMATION

{{company_name}}

{{company_address}}

Phone: {{phone}}

Email: {{email}}

Website: {{website}}

Date of Application: {{date_of_application}}

Legal Business Name: {{legal_business_name}}

Trading Name (if different): {{trading_name}}

Business Registration Number: {{business_registration_number}}

Date of Incorporation/Commencement: {{date_of_incorporation}}

Business Type (e.g., Sole Proprietor, Partnership, Pty Ltd): {{business_type}}

Primary Industry: {{primary_industry}}

Nature of Business Activity: {{nature_of_business_activity}}

CONTACT PERSON(S)

Main Contact Person Name: {{main_contact_person_name}}

Title: {{main_contact_person_title}}

Email: {{main_contact_person_email}}

Phone: {{main_contact_person_phone}}

Accounts Payable Contact Name: {{accounts_payable_contact_name}}

Accounts Payable Email: {{accounts_payable_email}}

Accounts Payable Phone: {{accounts_payable_phone}}

CREDIT REQUIREMENTS

Desired Credit Limit: {{desired_credit_limit}}

Purpose of Credit: {{purpose_of_credit}}

Anticipated Monthly Purchases: {{anticipated_monthly_purchases}}

BANKING INFORMATION

Bank Name: {{bank_name}}

Bank Address: {{bank_address}}

Account Name: {{account_name}}

Account Number: {{account_number}}

Branch Code: {{branch_code}}

Bank Contact Person (Optional): {{bank_contact_person}}

Bank Contact Phone (Optional): {{bank_contact_phone}}

TRADE REFERENCES

Please provide details of three (3) trade references with whom your company has established credit.

Reference 1: Company Name: {{reference_1_company_name}}, Contact Person: {{reference_1_contact_person}}, Phone: {{reference_1_phone}}, Email: {{reference_1_email}}, Account Number (Optional): {{reference_1_account_number}}

Reference 2: Company Name: {{reference_2_company_name}}, Contact Person: {{reference_2_contact_person}}, Phone: {{reference_2_phone}}, Email: {{reference_2_email}}, Account Number (Optional): {{reference_2_account_number}}

Reference 3: Company Name: {{reference_3_company_name}}, Contact Person: {{reference_3_contact_person}}, Phone: {{reference_3_phone}}, Email: {{reference_3_email}}, Account Number (Optional): {{reference_3_account_number}}

FINANCIAL INFORMATION

Annual Turnover (Last Financial Year): {{annual_turnover_last_year}}

Annual Turnover (Current Financial Year Projection): {{annual_turnover_projection}}

Net Worth: {{net_worth}}

Does your company prepare audited financial statements? {{audited_financial_statements_yes_no}} (If yes, please attach the latest audited statements.)

Are there any outstanding judgments, bankruptcies, or liquidations against your company or its directors? {{outstanding_judgements_yes_no}} (If yes, please provide details.)

OWNERSHIP / DIRECTORS / PARTNERS

List all principal owners, partners, or directors (attach separate sheet if necessary).

Name: {{owner_1_name}}, Title/Position: {{owner_1_title}}, % Ownership: {{owner_1_ownership_percentage}}

Name: {{owner_2_name}}, Title/Position: {{owner_2_title}}, % Ownership: {{owner_2_ownership_percentage}}

TERMS AND CONDITIONS

By submitting this application, I/we hereby authorise {{creditor_company_name}} to make enquiries as it deems necessary to assess our creditworthiness, including but not limited to contacting the above-listed references and obtaining credit reports from credit bureaus. I/we certify that the information provided in this application is true and correct to the best of my/our knowledge and belief.

I/we understand that standard payment terms are {{standard_payment_terms}} days from the date of invoice, unless otherwise agreed in writing. Overdue accounts may be subject to interest at a rate of {{overdue_interest_rate}}% per annum from the due date until paid in full.

I/we agree to notify {{creditor_company_name}} in writing of any material changes to the information provided in this application.

DECLARATION AND AUTHORISATION

I/We, the undersigned, declare that the information provided in this Business Credit Application is accurate and complete. I/We understand that any false or misleading information may result in the refusal of credit facilities.

I/We authorise {{creditor_company_name}} to obtain any information it considers necessary in connection with this application, including financial information and reports from credit reporting agencies.

Signature: __________________________

Printed Name: {{signatory_name}}

Title: {{signatory_title}}

Date: {{signature_date}}