APPLICATION FOR CREDIT

PLEASE COMPLETE ALL ITEMS BELOW WHERE REQUIRED

TRADING INFORMATION

DELIVERY ADDRESS

CONTACTS - RESPONSIBLE DIRECTOR / PRINCIPLE / OFFICER

DATE COMMENCED TRADING

-- dd/mm/yy

EXPECTED MONTHLY PURCHASES

$

TYPE OF TRADING ENTITY

SOLE TRADER PARTNERSHIP COMPANY ( COMPLETE FROM SECTION 11, BELOW )

NAMES AND PRIVATE ADDRESS FOR EACH PARTNER OR DIRECTOR

Name
Street Address
Address (cont.)
City
State
Postal Code
Work Phone
FAX
E-mail

NAMES AND PRIVATE ADDRESS FOR EACH PARTNER OR DIRECTOR

Name
Street Address
Address (cont.)
City
State
Postal Code
Work Phone
FAX
E-mail

NAMES AND PRIVATE ADDRESS FOR EACH PARTNER OR DIRECTOR

Name
Street Address
Address (cont.)
City
State
Postal Code
Work Phone
FAX
E-mail

NAMES AND PRIVATE ADDRESS FOR EACH PARTNER OR DIRECTOR

Name
Street Address
Address (cont.)
City
State
Postal Code
Work Phone
FAX
E-mail

DATE AND STATE OF INCORPORATION

-- dd/mm/yy

ISSUED AND PAID UP CAPITAL

$

ULTIMATE HOLDING COMPANY

A.C.N.

A.B.N.

BANK     

BRANCH

PLEASE PROVIDE THREE MAJOR SUPPLIERS REFERENCES NAME AND PHONE NUMBER.

a ) NAME PHONE #

b ) NAME PHONE #

c ) NAME PHONE #

APPLICATION DATE

-- dd/mm/yy