Astra Limousines Business Credit Application Form
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BUSINESS CREDIT APPLICATION FORM
Administration & Enquiries
Telephone +61 1300 130 855
Facsimile +61 1300 130 844
Name of Applicant Business/Company :
………………………………………………………………................
Address :
…………………………………………………………………………
…………………………………………………………………………
Postal Address :
…………………………………………………………………………
…………………………………………………………………………
Telephone :
…………………………….. Facsimile : ……………………........
Email :
…………………………………………………………………………
Website Address :
…………………………………………………………………………
: ……………………………………………………
: …………………………………
Nature of Business
Date commenced trading
: ……………………………………………….. …
: …………………………………………………..
Name of Director
Date of Birth
: ………………………………………
ABN Number
…………………………………………………………
If your company is a subsidiary or division of a parent company, please state name:
Trade References: 1 ………………………………………………………… Ph ……………………………. Fx ……………………………
2 ………………………………………………………… Ph ……………………………. Fx ……………………………
3 ………………………………………………………… Ph ……………………………. Fx ……………………………
Credit Card:
Type …………………
Name on Card …………………………………………………………
ID No …………………
Card # ………………………………………………………………... Expiry Date ………………………………………...
Credit card information is required to guarantee payment. Your nominated Credit Card will only be charged if payment has not
been received by the due date. Please note our trading terms are seven days from receipt of invoice.
I/We have read and agree with the Terms and Conditions herein.
Contact Name in Accounts Payable: …………………………………………………………….
Signature of Applicant (for and on behalf of): …………………………………………………………..
Please print full name: ………………………………………………………………
Names of persons authorized to charge to account:
1. ……………………………………………………………. 2. …………………………………………………………….
3. ……………………………………………………………. 4. …………………………………………………………….
Service Required:
Local: …………………………………… Interstate: …………………………………… Overseas: ……………………………………
Special Requests
……………………………………………………………………………………………………………
and/or
……………………………………………………………………………………………………………
instructions:
……………………………………………………………………………………………………………
……………………………………………………………………………………………………………
Executive offices: 5/221-223 O’Riordan Street Mascot NSW 2020 Australia
Astra Chauffeured Limousines of Australia Pty Ltd
ACN 086 088 664 ABN 91 086 088 664
Website Address
Email Address
.au
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Parent category: Business