Credit Application Form
Before filling in this Credit Application form please observe these requirements
before we can process it. These requirements are put into place as part of our Quality
(a) Your company requires a trading history with EMPR® Australia, either paid by
Credit Card or Direct Deposit.
(b) Trade References need to be Credit type, Not C.O.D. or other forms of Pre-Payment.
I / We the undersigned hereby make application for credit and provide the information
contained herein which is warranted to be true and correct, for the purpose of establishing
a credit account with EMPR® Australia.
Fields marked *are required.
Last Three Trade Reference :
Anticipated Monthly Expenditure :
Accounts Payable Details :
Your Details :
I / We agree to pay all accounts within the timeframe advised if credit is approved.
I / We also agree to pay any and all legal costs or collection fees and commissions
which may be incurred in recovery of any part of this account when it is not paid
with in the terms of days as stated above.
I / We understand that the credit facility, if extended, maybe withdrawn at the
discretion of the EMPR and that I / We shall be notified of such withdrawal.
By submitting this form you are confirming that you have read and understood the Terms & Conditions of EMPR® Australia.