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.