Confidential Credit Application - Department of Primary Industries

Section 5 - References
Bank
Name
Branch
Other Credit Providers (Please list at least 3)
Name of Person/Company Address Phone Number
( )
( )
( )
I/We hereby apply for the opening of a credit account with the Department of Primary Industries and Fisheries, and provide
the foregoing information in support of this application.
I/We understand that accounts when rendered are strictly net 30 days.
I/We undertake to pay all accounts by the due date and acknowledge that if the account becomes overdue, the Department of
Primary Industries and Fisheries reserves the right to withdraw or vary such credit limits as deemed appropriate from time to
time.
I/We agree to observe the provisions of the Copyright Act 1968 (Commonwealth) as amended from time to time and
undertake not to copy or reproduce in any form (written or otherwise) information, material, data or any other creation
provided by the Department without first obtaining the written consent of the Department.
I/We acknowledge receipt of and accept your General Terms and Conditions of Sale/Service.
Section 6 - Signatures of Authorised Person/s
If there is insufficient space for all signatories, please annex signatures to this application in the format, as set out below, which is
appropriate to your business operation.
Signature/s of Sole Trader or Partner/s authorised to sign on behalf of all Partners
1 2
Name
(Please Print)
Signature
Witnessed by
Name
(Please Print)
Signature
Name
(Please Print)
Signature
Witnessed by
Name
(Please Print)
Signature
Form FDU 326 03/04 Forms Management Unit