Please use the form below or click on this link to download a PDF
Application Form which you can fax to us.
You are applying for a Credit Account with Darjill Pty Ltd t/as Book and
Music Market
ABN: 3910 064040 ACN: 107064040
* indicated are required fields to have your
application submitted.
APPLICANT'S
DETAILS
*BUSINESS
NAME:
*ABN:
*TRADING
ADDRESS:
*SUBURB:
*STATE:
*POSTCODE:
*DELIVERY
ADDRESS:
*SUBURB:
*STATE:
*PCODE:
*TELEPHONE
NUMBER:
FAX NUMBER:
*EMAIL
ADDRESS:
*CONTACT
NAME:
*TYPE
OF BUSINESS:
IF COMPANY
COMPANY NAME:
REGISTERED
OFFICE ADDRESS:
DIRECTOR I NAME:
ADDRESS:
DIRECTOR II NAME:
ADDRESS:
MAILING ADDRESS:
SHAREHOLDER'S FUNDS:
$
AT
DATE OF INCORPORATION:
LAST AUDITED FINANCIAL STATEMENT
AVAILABLE
(IF REQUIRED)
IF PARTNERSHIP
PARTNER'S NAMES:
PRIVATE ADDRESS:
IF SOLE TRADER
PROPRIETOR'S NAME:
PRIVATE ADDRESS:
TRADE REFERENCES
*NAME:
*ADDRESS:
*TELEPHONE
NUMBER:
*(2)NAME:
*ADDRESS:
*TELEPHONE
NUMBER:
(3) NAME:
ADDRESS:
TELEPHONE NUMBER:
*AGREEMENT:
I/We certify the above details submitted
are to be true and correct.
