EMPR®Australia | Credit Application

Telephone Sales Call : 1800 663 384	An AS/ISO 9001:2008 Quality Endorsed Company
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credit application

Before filling in this Credit Application form please observe these requirements before we can process it. These requirements are put into place as part of our Quality Assurance System.

(a) Your company requires a trading history with EMPR Australia, either paid by Credit Card or Direct Deposit.

(b) Trade References need to be Credit type, Not C.O.D. or other forms of Pre-Payment.

I / We the undersigned hereby make application for credit and provide the information contained herein which is warranted to be true and correct, for the purpose of establishing a credit account with EMPR Australia.

company information

Company Name*
Trading Name*
Previous Trading Name (if applicable)
ABN*
ACN*
Address*
Suburb*
State*
Post Code*
Phone*
Website Address
Fax

directors information

[1] Name*
Address*
Suburb*
State*
Post Code*

[2] Name
Address
Suburb
State
Post Code

three(3) current trade references

[1] Company Name*
Email*
Fax
Contact*
Phone*

[2] Company Name*
Email*
Fax
Contact*
Phone*

[3] Company Name*
Email*
Fax
Contact*
Phone*

anticipated monthly expenditure

Expenditure $*

accounts payable details

Accounts Payable*
Accounts Email Address*

your details

(i) I / We agree to operate my/our accounts in accordance with your Companies Conditions of Sales (the principle conditions being noted below) and agree that all transactions are entered into on the basis of these Conditions. (ii) I / We hereby request to open a Monthly Credit Account and authorise you to make such enquiries as may be necessary to support this application. (iii) Each of the application / signatories / guarantors and / or Director(s): (a) guarantee the payment of your account(s) issued to the application (b) acknowledge and agree that the information contained in the commercial credit application form may be disclosed to a credit reporting agency or to another provider (c) agree that they will pursuant to the guarantee be jointly and severally liable for payment of the accounts(s) together with interest at the rate of 9% interest per annum calculated from the expiry date of the terms as provided within this application. (iv) I / We understand that the current Conditions of Sale, which have been supplied, may be varied from time to time by the company. (v) I / We understand that EMPR Australia Pty Limited may use the information provided in association with external credit agencies in order to verify the suitability of this credit application.

Your First Name*
Your Last Name*
Position*
Email*
I have read, understood and accept the Terms & Conditions