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COMMERCIAL CREDIT APPLICATION

KAFFEINA COMMERCIAL CREDIT APPLICATION

Please enter your details below. Fields marked with a * are required and must be completed.

COMPANY INFORMATION 
Applicants Business name  *
ABN  *
ACN 
Principal business address  *
Delivery address 
Contact name  *
Phone  *
Email Address  *

 

DIRECTOR/PARTNER DETAILS 

Names and Addresses

DIRECTOR/PARTNER DETAILS provide details of all directors and partners  *
DIRECTOR/PARTNER DETAILS provide details of all directors and partners 
DIRECTOR/PARTNER DETAILS provide details of all directors and partners 
OPERATING STRUCTURE  *
 
FINANCIAL DETAILS 
Business Premises  *
Owned
Leased

Bank  *
Bank Branch  *
Bank Contact  *
Bank Contact Email  *
Bank Contact Phone  *
Accountant  *
Accountant phone Number  *
 
TRADE/BUSINESS REFERENCES 
Trade Reference 1 - Name and Address  *
Trade Reference 1 - Phone Number  *
Trade Reference 2 - Name and Address  *
Trade Reference 2 - Phone Number  *
 
CREDIT REPORTING
To assist Kaffeina Group Pty Ltd (Kaffeina) in its assessment of the Applicant's credit application and its administration of credit and overdue payments, the Applicant, or if the Applicant is a company, then its directors, authorize Kaffeina pursuant to the Privacy Act 1988 to: 

  1. obtain a credit report containing personal credit information from a credit reporting agency;
  2. give details of personal credit worthiness, standing, history or capacity to a credit reporting agency or any actual or prospective guarantor  of the Applicant; and
  3. give to or receive from other credit providers a credit report or personal details of credit worthiness, history, standing and capacity.
Authorized signatory name.  *
I am authorised to make commitments on behalf of the business and I accept Credit Reporting Conditions.  * yes   no  
 
TERMS OF CREDIT 
Expected Monthly Purchases  *
Monthly Credit applied for  *
 
SIGNED BY
 
Name  *
Position  *
Email  *
Phone Number  *
If Kaffeina accepts this application I/we agree that the provision of goods and credit facilities to me/us are subject to Kaffeina’s Standard Conditions.  * yes   no  
Kaffeina’s Standard Conditions of Sale found here.
I am authorised to make commitments on behalf of the business  * yes   no  
I have read and agree to the terms presented in this application.  * yes   no  
I certify that the information I have given on the application is complete and correct  * yes   no  
Please enter the verification code in the image above *
 

 
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