Coleman's Accounts

Credit Application (Sole Trader or Partnership)

Name(s)

Date of Birth

Trading Name (If Applicable)

Address

Occupation / Business

Period of Employment / Time in Business
Years Months

Business / Mobile Phone

Home Phone Number
Email Address

Fax Number

ID - Drivers Licence / Pension Card / Credit Card
 Type ID Number

Business Information to Support this Application

Trade References ( Credit Accounts in force for more than 3 months )

Name:
Phone:
Address:

Name:
Phone:
Address:

Name:
Phone:
Address:

Premises:

Leased:
Expiry Date of Lease:

Rented:
Weekly:
Monthly:

Owned:


Bank:
Branch:

Declaration

I / We hereby declare that I / We believe that the above information is accurate. I / We apply for a credit account and understand that if credit is granted it is conditional upon complying with the following terms:

Supply of Furniture, Office / Computer / Communication Equipment: Settlement to be made COD.

Stationery Supplies: payment to be made within 30 days of issue of statement.

I / We acknowledge that Coleman's Office Products has informed me / us, in accordance with s.18(8)(c) of the Privacy Act 1988, that certain items of personal information about me / us contained in this application may be disclosed to a Credit Reporting Agency.