Application for Account

Please fill in this form and email it to us OR print this form and fax or mail it to us.

Applicant:

Trading as:

Address:

City/Sub.:

State:

Postcode:

Email:

WebSite:

I/WE HEREBY APPLY TO OPEN A CREDIT ACCOUNT WITH YOU AND FURNISH THE FOLLOWING PARTICULARS:

 IF A COMPANY:                         __                                                                                                                          

1st Director - First Name:

Middle Names:

Last Name:

Address:

Date of birth:

2nd Director - First Name:

Middle Names:

Last Name:

Address:

Business Address:

Registered Office:

 FOR INDIVIDUAL AND COMPANY APPLICANTS:                                     _                                                           

Business Structure (tick one)…

COMPANY:

PARTNERSHIP:

INDIVIDUAL or SOLE PROPRIETOR:

2nd Bus. Reference’s name:

3rd Bus. Reference’s name:

Phone:

Phone:

Phone:

Address:

1st Bus. Reference’s name:

Address:

Address:

Previous business address:

Years occupied:

2nd Director (signature):

1st Director (signature):

Print name:

Print name:

Print name:

Signature:

Signature:

Dated this day:

Signature:

Dated this day:

I/WE, THE ABOVE NAMED AND UNDERSIGNED, HEREBY REQUEST THAT YOU, SURFSANDS PTY. LTD., OPEN A CREDIT ACCOUNT FOR THE ABOVE NAMED APPLICANT AND IN CONSIDERATION OF THAT, I/WE JOINTLY AND SEVERALLY HEREBY AGREE TO INDEMNIFY YOU AND KEEP YOU INDEMNIFIED FROM AND AGAINST ALL DEBTS AND LIABILITIES WHICH THE ABOVE NAMED APPLICANT AND UNDERSIGNED MAY HENCEFORTH INCUR WITH YOU INCLUDING ANY INTEREST APPLIED TO THE APPLICANT’S ACCOUNT AT THE RATE PRESCRIBED BY THE PENALTY INTEREST RATES ACT 1983 ON OVERDUE ACCOUNTS AND INCLUDING ANY DEBT RECOVERY COSTS INCURRED BY YOU AND I/WE FURTHER AGREE THAT ANY SUCH DEBT OR LIABILITY SHALL BE PAYABLE BY US OR ANY OF US UPON YOUR WRITTEN DEMAND.  

For how long have the applicant’s business been conducted from the current business address:

Signed in the presence of;

Signed in the presence of;

 IN CASE OF INDIVIDUAL APPLICANT:                    _                                                                                             

ABN/ACN:

Phone:

Mobile:

APPLICATION FOR ACCOUNT

SURFSANDS PTY. LTD.  (ABN 35 003 226 999)  Suite 3, Level 11, 309 Pitt Street, Sydney, NSW, 2000

AUSTRALIAN GEM STONES

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