PDF Applications for 30 Day Account. - Humex

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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.
Page 1: ABN: 48 414 337 742APPLICATION FOR

PDF Applications for 30 Day Account. - Humex

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