Credit Application Form

Application Name (company name)

Trading Name in Full

ABN

Postal (Business) Address

P/Code

A/C Payable Contact

Phone

FAX

Email Address

Date Business Established

Type of Business

Business Structure

Sole Trader Partnership Company Trust

List Owners Or Directors Full Names & Addresses:

1. Full Name

Date Of Birth

Phone

Address

2. Full Name

Date Of Birth

Phone

Address

3. Full Name

Date Of Birth

Phone

Address

Trade Credit References (Do Not Include Freight Or Fuel Companies)

1. Phone

FAX

2. Phone

FAX

Credit Limit Requested

Are Purchase Orders Required For Payment?

Yes No

Terms
1. I / We understand & acknowledge by signing this application that Versa Services Pty Ltd t/as VRents (VRents) trading terms are net thirty days and I / we undertake to pay all accounts on the due date.
2. If the account balance becomes overdue, the account will automatically be suspended until it is brought within the trading terms.
3. I / We acknowledge upon acceptance of this application VRents will notify the applicant in writing of the applicants account credit limit. If the account credit limit is or may be exceeded the account must be paid in full.
4. I / We hereby certify that the above information is true & correct at the date of this application.
5. I / We hereby agree to advise VRents immediately upon any changes to the information contained in this application and of any changes to the business structure making this application. I / We further agree that any change to any of the above particulars is subject to written approval by the Credit Manager of VRents.
6. Should this application be accepted by VRents the applicant hereby agrees that the credit account shall be subject to the terms of this application and the usual terms and conditions of hire and trade of VRents, a copy of which is attached to this application and which the applicant has read, understands and agrees to abide by such terms and conditions of trade.
7. I / We hereby authorise VRents to contact those trade references listed as part of this application

Dated this

Day of

In The Year Of

Print Name Of Authorised Officer Of Applicant

Position

Signature Of Authorised Officer

Print Name Of Authorised Officer Of Applicant

Position

Signature Of Authorised Officer

Name of Witness

Signature of Witness

PRIVACY ACT DECLARATION
Versa Services Pty Ltd t/as VRents (VRents) hereby advises that, pursuant to the Privacy Act 1988, information disclosed in this credit application may be disclosed to a credit reporting agency. Under the regulations of the Privacy Act 1988 the applicant hereby agrees to VRents obtaining personal information from a credit reporting agency or a credit provider for the purpose of assessing this application for commercial credit, and agrees to that agency or provider providing that information to VRents for that purpose. The applicant agrees to VRents disclosing a credit report about the applicant to any credit provider, debt collection agency or other party for the purpose of assessing the applicant’s credit worthiness or to collect any overdue payments.

Dated this

Day of

In The Year Of

Print Name Of Authorised Officer Of Applicant

Position

Signature Of Authorised Officer

Name of Witness

Signature of Witness

Dated this

Day of

In The Year Of

Print Name Of Authorised Officer Of Applicant

Position

Signature Of Authorised Officer

Name of Witness

Signature of Witness

DEED OF GUARANTEE
I / We the undersigned in consideration of Versa Services Pty Ltd t/as VRents (VRents) agreeing to supply goods & services to the applicant on credit, hereby jointly & severally agree:
1. to guarantee unconditionally to VRents the due and punctual payment by the applicant of all monies now or hereafter owing to VRents relating to the supply by VRents of goods and/or services to the applicant; and the due observance & performance by the applicant of all its obligations under the terms & conditions of credit granted by VRents.
2. that VRents may act against the me/us or any of us as principal debtor(s) & I / we hereby waive all & any of my / our rights as surety’s which may at any time be inconsistent with this provision.
3. that this Guarantee shall be a continuing guarantee & shall not be revoked by the death of me/any of us or be impaired by any change in the members or shareholders of the applicant.

Dated this

Day of

In The Year Of

Print Name Of Authorised Officer Of Applicant

Position

Signature Of Authorised Officer

Name of Witness

Signature of Witness

Dated this

Day of

In The Year Of

Print Name Of Authorised Officer Of Applicant

Position

Signature Of Authorised Officer

Name of Witness

Signature of Witness

Credit Application Form

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