Join The Team
Contact Us
0407 199 196
Our Fleet
CONCRETE PUMPING SERVICES
SHOTCRETE SERVICES
Equipment Sales
About Us
Safety and Training
Projects
Credit Application
Form
To be completed by Applicants – please complete all sections and read the Terms and Conditions of Trade overleaf
Date
(Required)
MM slash DD slash YYYY
REF No
CLIENTS TRADE NAME
CLIENT FULL or LEGAL NAME
(Required)
Phone
Fax
Mobile
Email
(Required)
Billing Address
(Required)
Postcode
(Required)
Physical Address
Postcode
COMERCIAL CLIENTS ONLY
ABN/ACN Number
Requested Credit Limit
Date Established
MM slash DD slash YYYY
Contact 1
Phone
Position
Contact 2
Phone
Position
DETAILS OF OWNER (if Sole Trader) PARTNERS (If Partnership) OR DIRECTORS (If Company)
Full Name
Home Phone
Home Address
Full Name
Home Phone
Home Address
TRADE REFERENCES
Business Name 1
Address or A/C No
Phone
Fax
Business Name 2
Address or A/C No
Phone
Fax
I certify that the above information is true and correct and that I am authorised to make this application for credit. I have read and understand the TERMS AND CONDITIONS OF TRADE (overleaf or attached) of A & L Concrete Pumping Pty Ltd T/A Citywest Concrete Pumping which form part of and are intended to be read in conjunction with this Credit Account Application and agree to be bound by these conditions. I authorise the use of my personal information as detailed in the Privacy Act clause therein.
I agree that if I am a Director/Shareholder (owning at least 15% of the shares) of the Client I shall be personally liable for the performance of the Client’s obligations under this contract.
SIGNED (CLIENT)
(Required)
Name
(Required)
Position
ID
DOB
MM slash DD slash YYYY
Consent
(Required)
I agree to the General terms and conditions of trade for services..
Read the General Terms and Conditions of Trade for Services
CAPTCHA
Menu