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Become a Customer
| Apply for a Credit Account
(Food Retailers and Food Wholesalers
only)
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*Indicates Required |
| Prefered User Name: |
* |
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| Password: |
* |
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| Business Name: |
* |
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| Trading As: |
* |
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| ABN Number: |
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| ACN Number: |
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| Is your business a: |
* |
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Business Type
(If not on list, select "other" & fill in the field below
the list) |
*
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Certification Association
(if applicable) |
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| If Certification
Association "Other/International" please enter
here |
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| 1. Business Address:
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* |
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| Postcode: |
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| State: |
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| Country: |
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| Phone: |
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| Fax: |
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| www: |
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| Email: |
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Date of commencement
of
Business eg: 22/12/1985 |
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| Estimated Weekly Purchases: |
$
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| Would you accept backorders?
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2. Postal Address:
(if different to Business Address) |
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| Postcode |
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3. Registered Office:
(if different to Business Address) |
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| Postcode: |
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| Phone: |
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| Fax: |
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4. Delivery Address:
(if different to Business Address) |
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| Postcode: |
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| Licensed Premises: |
| Name: |
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| Address: |
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| Postcode: |
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| Phone: |
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| Licensee's Name: |
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| Licence Number: |
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Sales Tax Exemption
No
(if applicable): |
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| Account Contact Details: |
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| Postcode: |
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| Previous Licensed Premises
Held: |
| 1. Name: |
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| Address: |
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| Date From: |
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| Date To: |
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| 2. Name: |
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| Address: |
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| Date From: |
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| Date To: |
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| Sole trader/Partner(s)/Director(s) |
| 1. Name: |
* |
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| Private Address: |
* |
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| Postcode: |
* |
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| Phone: |
* |
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| 2. Name: |
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| Private Address: |
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| Postcode: |
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| Phone: |
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| 3. Name: |
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| Private Address: |
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| Postcode: |
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| Phone: |
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Trade References
(please give at least 3) |
| 1. Name: |
* |
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| Address: |
* |
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| Postcode: |
* |
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| Phone: |
* |
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| 2. Name: |
* |
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| Address: |
* |
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| Postcode: |
* |
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| Phone: |
* |
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| 3. Name: |
* |
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| Address: |
* |
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| Postcode: |
* |
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| Phone: |
* |
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| Banking Details |
| Name: |
* |
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| Branch Address: |
* |
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| Postcode: |
* |
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| Phone: |
* |
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| Manager: |
* |
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I/We the persons, whose
details are provided on the front of this credit application
("Applicant"), apply for a trading account with World Whole
Foods Pty Limited. The Applicant acknowledges that the granting
of credit to the Applicant is at the sole discretion of World
Whole Foods Pty Limited and may be varied by World Whole Foods
Pty Ltd from time to time as it sees fit. The terms of credit
are set out below ("Agreement - Terms and Conditions - Supply").
Variations shall be notified to the applicant in writing and
signed by an authorised officer of World Whole Foods Pty Limited.
The Applicant authorises World Whole Foods Pty Limited to:
- disclose the credit information providing this information
to a credit reporting agency
- give, receive and exchange credit information to, from
and with credit reporting agencies, credit providers (whether
listed in this application as credit referees or not),
bankers and such persons or entities as thought fit for
the purpose of assessing this application or to assist
in collecting any payment which becomes overdue.
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Payment may be made by credit
card for your convenience.
Please complete details below: |
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Authority to debit credit
card
I hereby authorise World Whole Foods Pty Limited to charge
to my nominated credit card account for goods ordered by me/my
business/company by telephone, fax e-mail or mail from the
date below until the closure of my account or as advised by
me in writing. |
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| Name of Card: |
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| Type of Card: |
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| Card Number: |
-
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-
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| Expiry: |
/
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