Account Credit Application

The applicant

Applicant's name (company or person applying) *

Trading as

ABN *

Postal address *

Mobile phone number *

Accounts email *

The applicant is a *

Affiliated with or a subsidiary of a trading group or holding company? *

Business commenced date

Credit required per month

Order number required on invoices?

Directors, partners or proprietors

Names and addresses of all directors, partners or proprietors. Fill in as many as apply.

1. Family name

Given name

Address

Date of birth

2. Family name

Given name

Address

Date of birth

3. Family name

Given name

Address

Date of birth

4. Family name

Given name

Address

Date of birth

Trade references

1. Name

Phone

Email

2. Name

Phone

Email

3. Name

Phone

Email

Declarations

I/We authorise HVCPS to obtain and give credit information about me/us as set out in the Privacy Authority in the application form (PDF). * I/We have read and understand the Standard Contract Terms in the application form, and agree that the terms current at the time apply to transactions between us. * I/We declare the information in this application is correct. *

The signature and personal guarantee pages of the application are completed on the printed form. After you submit, we will come back to you about the signed copy and anything else needed to open the account.

Account credit application

The applicant

Directors, partners or proprietors

Trade references

Declarations