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 / We agree to pay all accounts within days of the date of issue shown on each invoice. I / We also agree to pay any and all legal costs or collection fees and commissions which may be incurred in recovery of any part of this account when it is not paid with in the terms of days as stated above. I / We understand that the credit facility, if extended, maybe withdrawn at the discretion of the EMPR Australia Pty Ltd and that I / We shall be notified of such withdrawal.

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