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 Assurance System.

(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.

     Application Type

Company Information :

Director Information :

 

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I / We understand that the credit facility, if extended, maybe withdrawn at the discretion of the EMPR and that I / We shall be notified of such withdrawal.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.