Business Credit Application

APPLICANT INFORMATION

{{company_name}}

{{company_address}}

Phone: {{phone}}

Email: {{email}}

Website: {{website}}

SOLE PROPRIETOR/PARTNERSHIP/CORPORATION

BUSINESS DETAILS

Legal Name of Business: {{legal_business_name}}

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

Business Registration Number: {{business_registration_number}}

Date of Establishment: {{date_of_establishment}}

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

Nature of Business/Industry: {{nature_of_business}}

Physical Address: {{physical_address}}

Postal Address: {{postal_address}}

Primary Contact Person: {{contact_person_name}}

Contact Person's Title: {{contact_person_title}}

Contact Person's Phone: {{contact_person_phone}}

Contact Person's Email: {{contact_person_email}}

BANKING INFORMATION

Bank Name: {{bank_name}}

Account Name: {{account_name}}

Account Number: {{account_number}}

Branch Name: {{branch_name}}

Bank Contact Person (if applicable): {{bank_contact_person}}

TRADE REFERENCES

Please provide details of at least three trade references with whom your business has established credit.

Reference 1:

Name of Company: {{reference1_company_name}}

Contact Person: {{reference1_contact_person}}

Phone Number: {{reference1_phone}}

Email Address: {{reference1_email}}

Account Number (if applicable): {{reference1_account_number}}

Reference 2:

Name of Company: {{reference2_company_name}}

Contact Person: {{reference2_contact_person}}

Phone Number: {{reference2_phone}}

Email Address: {{reference2_email}}

Account Number (if applicable): {{reference2_account_number}}

Reference 3:

Name of Company: {{reference3_company_name}}

Contact Person: {{reference3_contact_person}}

Phone Number: {{reference3_phone}}

Email Address: {{reference3_email}}

Account Number (if applicable): {{reference3_account_number}}

CREDIT REQUIREMENTS

Desired Credit Limit: {{desired_credit_limit}}

Purpose of Credit: {{purpose_of_credit}}

Proposed Payment Terms (e.g., 30 days, 60 days): {{proposed_payment_terms}}

DECLARATION AND AUTHORISATION

I/We declare that the information provided in this application is true and correct to the best of my/our knowledge. I/We authorise {{creditor_company_name}} to make enquiries as considered necessary to verify the information contained herein, including obtaining credit reports and contacting the provided references and financial institutions. I/We understand that providing false or misleading information may result in the rejection of this application or termination of any credit extended.

SIGNATURE BLOCK

_______________________________

Signature of Authorised Representative

Name: {{authorised_representative_name}}

Title: {{authorised_representative_title}}

Date: {{date}}