Credit Application Form - Plant Hire Solutions Australia

Please complete all sections and read the Terms and Conditions of trade overleaf or attached.

Date

Ref No.

Customer's Trade Name

Customer's Full or Legal Name

Phone

Billing Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Physical Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

ABN

ACN

Requested Credit Limit

Date Established

Contact 1

First Last

Position

Phone

Contact 2

First Last

Position

Phone

DETAILS OF OWNER/S (if Sole Trader) PARTNERS (if Partnership) or DIRECTORS (if company) or TRUSTEE (if a Trust)

Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Date of Birth

Phone

I certify that the above information is true and correct and that I am authorised to make this application for credit. I have read and understand the Terms and Conditions of trade (overleaf or attached) of Plant Hire Solutions Australia Pty Ltd which form part of, and are intended to be read in conjunction with this Credit Account Application and agree to be bound by these conditions. I authorise the use of my personal information as detailed in the Privacy Act clause therein. I agree that if i am a director/owner/partner/trustee of the Customer I shall be personally liable for the performance of the Customer’s obligations under this contract.,

Signature

Name

First Last

Position

DETAILS OF OWNER/S (if Sole Trader) PARTNERS (if Partnership) or DIRECTORS (if company) or TRUSTEE (if a Trust)

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