Company/Individual data
Applicant Name
Company Or BusinessName
Tel   Fax   Mobile  
ABN   ACN
Registered Trading Name  
Postal Address 
Delivery Address (Only if different) ____________________________________________________________________________________________________________________
Corporate Structure (Tick appropriate box)

Public Limited company	Proprietary Limited	Family Trust
Partnership	Incorporated Body	Sole Trader

Have you ever filed bankruptcy as an individual, partnership, or shareholder in a corporation? Y N
__________________________________________________________________________________________________________________ 

Applicant’s Financials (Tick appropriate box)
Trading premises Owned Leased        Date Business Commenced
Bank and branch
Banker’s name and phone
____________________________________________________________________________________________________________________

Trade Credit References:
(It is extremely important to get this information clearly)
1 Tel Fax
2 Tel Fax
3 Tel Fax

____________________________________________________________________________________________________________________

Full Names and addresses of Directors/ Partners/ Trustees/ Proprietors (Important info)
1  Name Date of birth
    Address
    Driver’s License Number

2  Name: Date of birth
    Address
    Driver’s License Number

Terms and Conditions
1. RANS may in assessing my/our application for credit or if the application is accepted and subsequently payment becomes overdue may obtain personal information from a credit reporting agencies and/or the credit providers information about my/our credit arrangement and I/we understand that this information may include my/our credit worthiness, credit history and/or credit capacity that the credit providers are allowed to give or receive pursuant to the Privacy Act and Privacy Amendment Act.
2. All contracts between RANS and the applicant shall be deemed to have been entered into in the State of Victoria and shall be constructed to the Laws of the State of Victoria.
3. Applicants must inform RANS in writing within seven (7) days of any changes to the business or corporate structure.
4. RANS reserves the following rights to any goods supplied to the applicant by RANS, until all accounts owed by the applicant to RANS are fully paid and have been cleared by the bank.
4.1 legal ownership of the goods.
4.2 to enter the applicant’s premises (or the premises of any associated company or agent where the goods are located)
4.3 keep or resell any goods possessed
5. I/We acknowledge that if the account is overdue, RANS at its discretion, reserves the right to refer the account to a Mercantile Agency for collection and I/We agree to pay the full amount of any costs or expense, including reasonable legal fees incurred by RANS in the collection of such overdue amounts by litigation or otherwise.
6. The ownership of the goods supplied by RANS to the applicant is only transferred to the applicant when all amounts corresponding to the supplied goods have been paid and payment has been cleared by the bank.
7. RANS reserves the right to enter applicant’s premises without the liability of trespassing or any resulting damage and retake possession of the goods.
8. I/We acknowledge and agree that the terms of payment are strictly net 30 days from the date of statement. In the event the account becomes overdue, RANS reserves the right to charge interest in accordance with the Penalty Interest Rates Act 1983.
9. Customer assumes all insurance and delivery risks or damage at FOB point. The responsibility of determining insurance is that of the buyer.
10. Return of stock will not be accepted without prior authorisation, claims of short supply or faulty stock will only be considered by RANS if a request is received within 7 working days from the date of Invoice.
11. Clerical errors are subject to correction.
12. All orders are subject to approval and acceptance by RANS.
I/We acknowledge that the information provided within this application has been read and understood by me/us and I/we declare that the information is true and correct in every detail and I/we acknowledge that if credit is given, credit will be provided in reliance upon the information supplied by me/us herein.

Signature ______________________________________
Full Name ______________________________________
Date __________

Signature ______________________________________
Full Name ______________________________________
Date __________

RANS controlled document number: CD131 version 1.2 last update 19/11/2007