Application for Credit Form

Collects a company's details, directors, and trade references needed to evaluate a credit line for one or more venues.

Use this template

Section

Company / Entity Name ("The Customer")

Billing Address

Dirección

Ciudad

Estado / Provincia

Código postal

ABN

Billing Contact Person

Nombre

Apellido

Phone Number

Billing Email for Invoices

Additional Billing Emails (Optional)

Credit Limit per Venue (optional)

Preferred Contact Days (optional)

Section

Please provide the details for each company director.

Director #1 Name

Nombre

Apellido

Residing Address (For credit purposes only)

Dirección

Ciudad

Estado / Provincia

Código postal

Phone Number

Section

Provide the details for each venue requesting credit.

Main Store / Trading As Name

Delivery Address

Dirección

Ciudad

Estado / Provincia

Código postal

Delivery Times and Instructions (Optional)

Liquor License #

Venue Email (for invoices)

Section

Second Store / Trading As Name

Delivery Address

Dirección

Ciudad

Estado / Provincia

Código postal

Delivery Times and Instructions (Optional)

Liquor License #

Venue Email (for invoices)

Third Store / Trading As Name

Delivery Address

Dirección

Ciudad

Estado / Provincia

Código postal

Delivery Times and Instructions (Optional)

Liquor License #

Venue Email (for invoices)

Fourth Store / Trading As Name

Delivery Address

Dirección

Ciudad

Estado / Provincia

Código postal

Delivery Times and Instructions (Optional)

Liquor License #

Venue Email (for invoices)

Section

Director #2 Name

Nombre

Apellido

Residing Address (For credit purposes only)

Dirección

Ciudad

Estado / Provincia

Código postal

Phone Number

Section

Trade Reference #1 Name

Phone Number

Trade Reference #2 Name

Phone Number

Section

The person signing below confirms the accuracy of this application.

Name of Signatory (Print)

Position

Signature

Sign here

Date

Application for Credit Form

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