Book and Music Market - Wholesale distributor of Remainder, Promotional & Discount Books

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: 3910 064040 ACN: 107064040

* indicated are required fields.

APPLICANT'S DETAILS
*BUSINESS NAME:
*ABN:
*TRADING ADDRESS:
*SUBURB:
*STATE:
*POSTCODE:
*DELIVERY ADDRESS:
*SUBURB:
*STATE:
*PCODE:
*TELEPHONE NUMBER:
FAX NUMBER:
MOBILE PHONE:
*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.

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