Trade Application Form - Maxis Dental Repair Solution

Credit Account Application

Maxis Dental Repairs

Bonnyrigg Heights, New South Wales 2177, Australia

0406 445756

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Company Name *

Legal Entity: * Limited Co Partnership Sole Trader LLP

Invoice Address

Address Line 1 *

Address Line 2

City *

State *

Post Code *

Country *

Registered Office: (If same as Invoice address leave blank)

Address Line 1 *

Address Line 2

City *

State *

Post Code *

Country *

Tel No: *

Mobile: *

Mobile Number for Parcel Tracking:

Contact Name: *

Position in the Company: *

Order Confirmation & Tracking Email: *

ABN Registration No: *

Accounts Email: *

Established (No of Years): *

Partner 1/Director 1

Name *

Home Address *

Phone Contact *

Partner 2/Director 2

Name *

Home Address *

Phone Contact *

Bank Reference for Refunds

Bank Name *

Account Name *

Branch Address *

Telephone No: *

Account Open Since *

Telephone Number *

Duration of Relationship *

Trade Reference 1

Company Name *

Contact Name *

Address *

BSB No: *

Account Number *

Credit Limit *

Trade Reference 2

Company Name *

Contact Name *

Address *

BSB No: *

Account Number *

Credit Limit *

Expected Monthly Sales *

Max Amount of Credit Required: *

Agreement to the Company’s Terms and Conditions of Sale

1. I have read and understood the Company’s Terms and conditions for the Supply of Goods and Service and agree to abide by them.
2. I am aware that the Company must be notified of any discrepancies or queries as follows:

• Invoice queries or Product quantity or description problems – within 7 days of receipt
• Overdue account balance will incur surcharge @ 1% calculated daily.
• All shipping will be solely on customers behalf and MDRS will not take responsibility of any damages if occurred by the courier company.
• Customer to report any damages or malfunction within 24hrs of receipt of goods

3. I confirm acceptance of the Company payment terms of 7 days from the invoice date.
4. I give my consent to a credit search being made on me as owner/partner or director of this organization both now & at any future date. I understand this search will be recorded by the agency & may be disclosed to subsequent enquirers.
5. I the undersigned as an Officer of the applicant business hereby personally guarantee payment of all monies due for goods supplied by the company and in accordance with their terms and conditions of sale, a copy of which I acknowledge having received.
(To be signed by a director/partner of the company authorized to agree such matters.)

Signatory 1 *

Date *

Print Name *

Position *

Signatory 2 *

Date *

Print Name *

Position *

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