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APPLICATION TO OPEN A 30 DAY COMMERCIAL CREDIT ACCOUNT

This is an application for a commercial credit account (Application) relating to the supply of goods by means Keelangie Nominees Pty Ltd (ACN 005 226 497) as trustee for the DG & CV Jewell Family Trust trading as “Jewell Tyres”(Jewell Tyres) on the terms and conditions (as may be varied from time to time) that regulate the supply, including (without limitation) the following documents included in this Application:
1. Terms and Conditions of Trade;
2. Deed of Guarantee and Indemnity (to be completed for Company/Trusts).
IMPORTANT WARNING
THIS IS AN IMPORTANT DOCUMENT. IF YOU SIGN IT, YOU ARE UNDERTAKING SIGNIFICANT FINANCIAL OBLIGATIONS. BEFORE YOU SIGN IT YOU SHOULD SEEK INDEPENDENT LEGAL AND FINANCIAL ADVICE.
Please complete this Application in full and return it to us. We will notify you in due course as to whether your Application has been successful. Submission of this Application does not in any way oblige us to provide or continue providing credit.

GENERAL DETAILS
Legal Name of Purchaser:________________________________________________________________
(le Company, Mal, individual)
____________________________________________________________________________________ (“Purchaser’)
Trading Name of Purchaser:_______________________________________________________________
ACN of Purchaser:_____________________________ ABN of Purchaser:_________________________
Business Name and Registration Number:____________________________________________________
Nature of Business:_____________________________________________________________________
Date Business Commenced:
Type of Business: q Public Company q Private Company q Trust q Partnership q Sole trader qOther:
(provide details)
If a trust, registered trust name:______________________________________ Please provide copy of deed
Credit requested: $________________ (monthly credit required)
Has Purchaser applied for a commercial credit account with Jewell Tyres previously? q Yes / q No
If so, when?_____________________________________________________________ _ (provide details)
Internet Address:_______________________________________________________________________
Postal Address:_____________________________________________ Suburb:____________________
State:___________________________________ Post Code:_______ Country:____________________
Delivery Address:___________________________________________ Suburb:____________________
State:___________________________________ Post Code:________ Country:____________________
Business Address:__________________________________________ Suburb:____________________
State:___________________________________ Post Code:_______ Country:____________________
Telephone (Accounts): ( ….)___________________ Facsimile (Accounts):( )____________________
Email (Accounts):_____________________________ Mobile (Accounts): _________________________

DIRECTORS, PARTNERS OR PROPRIETORS
1 Name in Full
Date of Birth
Position/Occupation
Licence No
Residential Address
Owned [ ] Buying [ ] Renting [ ]
Postcode
2 Name in Full
Date of Birth

Position/Occupation
Licence No
Residential Address
Owned [ ] Buying [ ] Renting [ ]
Postcode

3 Name in Full
Date of Birth
Position/Occupation
Licence No
Owned [ ] Buying [ ] Renting [ ]

BANK DETAILS
Bank Name:_____________________________________________ Branch/State_____________________
Account Name:__________________________________________________________________________
B.S.B.No:_____________________________________________________________________________
Account No:___________________________________________________________________________

FINANCIAL DETAILS
Assets (Last Financial Year) A$:____________________ Liabilities (Last Financial Year) $A:_____________
Revenue (Last Financial Year) A$:__________________ Net Profit (Last Financial Year) $A:______________

Please provide details of all charges, mortgages or other security interests over assets of the Purchaser:

Please provide a copy of the Purchaser’s Statement of Financial Performance, Statement of Financial Position and Statement of Cash Flows for the Last Financial Year.

Within the last 3 years has any Proprietor, Director or Manager of the Purchaser been the subject of bankruptcy proceedings or been associated with a business which has failed or been the subject of a scheme of arrangement, receivership, voluntary administration, liquidation or to which an Administrator or Controller has been appointed? q Yes / q No

TRADE REFERENCES (minimum 3 required substantiating credit requested)
1. Name:________________________________________________________________________

Address:_______________________________________________________________________

Telephone:_________________________________ Fax:____________________________
2. Name:________________________________________________________________________

Address:_______________________________________________________________________

Telephone:_________________________________ Fax:_________________________________
3. Name:________________________________________________________________________

Address:_______________________________________________________________________

Telephone:_________________________________ Fax:_________________________________
4. Name:________________________________________________________________________

Address:_______________________________________________________________________

Telephone:_________________________________ Fax:_________________________________

 

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