Expressway Transport Account Application

Expressway Transport Account Application

I/We hereby apply for credit and submit the following information:

Company Name

Company Name :: Enter Company Name

Trading As:

Trading As: :: Please select company type

Name of Pty Ltd Company

Name of Pty Ltd Company :: Pty Ltd company name if applicable

ABN #:

ABN #: :: Enter your ABN Number

Type of Business:

Type of Business: :: For example: Spare Parts, Lawyers or Real Estate

Street Address:

Street Address: :: Physical Address of Business

Postal Address

As Above

Postal Address:

Postal Address: :: Address for Post if different from above

Phone:

Phone: :: Phone

Fax:

E-Mail Address

E-Mail Address :: Email

Directors/Partners Names

Directors/Partners Names :: Please enter executive names

Phone #:

Phone #: :: Contact phone number:

Local Accounts Contact Name:

Local Accounts Contact Name: :: Enter name

Phone #:

Phone #: :: Phone

Eastern States Contact Name:

Eastern States Contact Name: :: Only if applicable

Phone #:

Phone #: :: Phone

Trading References:

1. Business Name & Address

1. Business Name & Address :: Address of reference

Contact Name & Phone Number

Contact Name & Phone Number :: Name & Number

2. Business Name & Address:

2. Business Name & Address: :: Name & address of reference

Contact Name & Phone Number

Contact Name & Phone Number :: Name & number

Terms:

Terms of payment are strictly 14 days from date of invoice. Accounts in arrears will be charged an overdue fee and may be suspended. By electronically signing below you agree and acknowledge these terms.

Name

Position

I/We accept

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