Credit Application Form

INFORMATION

Fill up all information needed to submit

Company Name*

Trading As*

Type of Business*

ABN / ACN*

Pick up Address*

Billing Address*

Telephone*

Fax*

Director/s*

Accounts Contact*

Bank and Branch*

Trade References

Trading: Estimated level of credit required per week $*

TERMS: NET 7 DAYS

I, the authorised Officer representing the Company / Business named herein, accept the standard Terms and Conditions of Contract clarified on Carrier Consignment Notes; and undertake the Terms of Trading as agreed together with Australian Transport Management, including rates presented and held on behalf of the customer. I understand Insurance is not provided.

Director / Authorised Officer Name*

ATM Representative*

Date*