Book and Music Market | Credit Application
Book and Music Gold Coast
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Book and Music Supplier Labrador Gold Coast
Credit Application
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: 39 107 064 040 ACN: 107 064 040
* indicated are required fields to have your application approved.
APPLICANT'S DETAILS
*NAME/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
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.
 
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