APPLICATION FORM TO BECOME AN S&S STOCKIST

Please note: As a matter of good business practice, we require all new customers to complete an application form for our records and we thank you for taking the time to do so.
Application Trading /
Business Name
Company Name
Australian Business Number (ABN)
Trading Business Address
City / Suburb
State *
Post Code
Telephone Number
Fax Number
Web Address
Type / Nature of Business
Period of Trading Under Current Ownership
Previous Business / Employer is trading less than 12 months
Name / Employer
Phone / Fax Number
Business Premises are
Account Contact Person / Phone No.
Estimated Monthly Purchases
Do You Accept Freight-Free Backorders
Would you like Statements, Invoices & Quotes Sent By Email
If yes, please enter email address

Name and Address of Proprietor / Director / Partner

Surname
Given Name
Sex
Date of Birth
Driving Licence No
Address
City / Suburb
State
Post Code
Country

Trading References (i.e. established accounts with trade suppliers)

Name of Supplier Location Phone No Fax No Monthly Purchases
1. (Avg)$
2. (Avg)$
I / We confirm that the information supplied is correct and agree that S&S Wholesale Pty Limited may supply, exchange and access commercial and consumer credit information with other credit providers and reporting agencies in oder to access my / our credit worthiless in support of this application
I / We acknowledge having received, read and fully understood the Terms and Conditions of sale of S&S Wholesale Pty. Ltd. attached to this application and agree to comply with them
I / We understand that the goods purchased by me / us must be paid for within thirty (30) days from the end of the month in which they were invoiced. If at any time amounts become overdue for payment, I / We agree that the balance of the accounts will become payable and credit account facilities suspended.
I am authorised to agree to the terms and conditions of this application on behalf of the applicant(s) and its officers.