3PM Credit Application Form

"*" indicates required fields

• First invoice is always payable upfront
• From there billing is 1st of the month due 14 days after invoice

1. Business Details

Legal Entity Name:*

Trading Name (if different):

ABN / ACN:*

Business Structure:*

eg Sole Trader / Partnership / Company / Trust

Registered Office Address:*

Trading Address:*

Website:*

Years in Business:*

Estimated Monthly Spend (AUD):*

Credit Limit Requested (AUD):*

2. Accounts Payable Contact

Name:*

Role/Title:*

Email:*

Phone:*

Purchase Order Required?*

Yes / No

Accounts Payable Address (if different):

Preferred Delivery of Invoices/Statements:*

Email / Portal / Other

Invoice Email(s):*

3. Directors / Proprietors / Trustees

(Person 1) Full Name:*

(Person 1) Date of Birth:*

(Person 1) Residential Address:*

(Person 1) Email*

(Person 1) Phone*

(Person 2) Full Name: (Optional)

(Person 2) Date of Birth: (Optional)

(Person 2) Residential Address: (Optional)

(Person 2) Email: (Optional)

(Person 2) Phone: (Optional)

(Person 3) Full Name: (Optional)

(Person 3) Date of Birth: (Optional)

(Person 3) Residential Address: (Optional)

(Person 3) Email: (Optional)

(Person 2) Phone: (Optional)

4. Trade References

3 Australian suppliers preferred

Reference #1: Company*

Reference #1: Contact*

Reference #1: Email*

Reference #1: Phone*

Reference #2: Company*

Reference #2: Contact*

Reference #2: Email*

Reference #2: Phone*

Reference #3: Company*

Reference #3: Contact*

Reference #3: Email*

Reference #3: Phone*

5. Banking Details (for direct debit)

Bank:

BSB / Account (last 4 digits):

Account Name:

6. Direct Debit

To streamline payments, please complete our direct debit authority here: https://pay.gocardless.com/BRT0002MAKFJJPN

7. Trading Terms & Conditions

I/We have read and agree to be bound by the Trading Terms & Conditions

8. Late Payment Fees & Interest

9. Privacy & Credit Checks (Australia)

10. Declarations

11. Execution & E-Signature

Authorised Signatory Name:*

Position/Capacity:*

Date:*

Signature*