PDF Applications for 30 Day Account. - Humex

ABN: 48 414 337 742APPLICATION FOR 30 DAY CREDIT ACCOUNT WITHHUMEX EXHAUSTS925 CALIMO STREET, ALBURY NSW 2640Phone No: (02) 6571 9600 - Fax No: (02) 6578 8690Customer Trading Name ____________________________________________________Company Name (If Different To Above)_________________________________________Business ABN/ACN Number:Business Address _________________________________________________________Postal Address____________________________________________________________Phone No__________________ Fax No_______________________________________Premises – Owned ( ) Rented ( )Type Of Business____________________ Established For_____YearsSole Trader ( ) Partnership ( ) Limited Company ( )Bank_________________ Branch_________________ Phone No__________________Name Of Directors/Partners/Proprietor (Attach List If More Than Three)1._______________________ Address_______________________________________Drivers Licence No_____________ Home Status: Own ( ) Mortgaged ( ) Rent ( )2. ._______________________ Address______________________________________Drivers Licence No_____________ Home Status: Own ( ) Mortgaged ( ) Rent ( )3. ._______________________ Address______________________________________Drivers Licence No_____________ Home Status: Own ( ) Mortgaged ( ) Rent ( )Financial Information if a Limited Company taken from Balance Sheet Dated / /Paid Up Capital____________________________Shareholders Funds_______________% of Total Liabilities to Total Assets___________________________________________Is the Company at the Date of this application paying all its debts as they becomedue?__________Is applicant affiliated to, connected with, or a subsidiary of a trading group or holdingcompany?If so, give name & location of principal company______________________________________________________________________________________________________________________________________________

APPLICATION FOR CREDIT ACCOUNT WITH HUMEX EXHAUSTS (CONTINUED).Trade ReferencesOffice Use OnlyName: ___________________________ A/C Est Years Amount 1 Mth PMTLocation: _________________________Phone No: ________________________Contact: __________________________Name: ___________________________Location: _________________________Phone No: ________________________Contact: __________________________Name: ___________________________Location: _________________________Phone No: ________________________Contact: __________________________I / We as Director /Partners /Proprietor declare the above information to be true and complete inevery respect, apply to open a Credit Account with your firm and if credit should be granted undertaketo settle your account within the agreed terms.(Payment due and payable on 25 th of month followingdate of purchase). I / We agree to terms and conditions as printed in the Humex Exhaust Catalogueand to the addition of interest at the rate of 2½ % monthly to any overdue amount. The signatorieshereby jointly and severally personally guarantee all payments due hereunder.Signed_____________________________________ Date / /Director ( ) Partner ( ) Proprietor ( )Signed_____________________________________ Date / /Director ( ) Partner ( ) Proprietor ( )On behalf of _______________________________________________________Account Number_________________ Clearance_______________Date / /

TO WHOM IT MAY CONCERNI, (Name) ___________________________________________________________Of (Address) ________________________________________________________(Occupation) ________________________________________________________(Date Of Birth) _______________________________________________________provide my authority:A) to all corporations or individuals carrying on a credit reporting business;B) to all corporations or individuals carrying on business as credit providers;C) to all keepers of records,to disclose and release to HUMEX EXHAUSTS all and any credit reports (includingany personal information contained in such reports) or any other information whichmay be relevant to HUMEX EXHAUSTS for the purpose of allowing that company toassess an application for credit which has recently been made by me to thatcompany.DATED this _______________day of _______________ 200___…………………………………………….Applicant…………………………………………….Witness.