APPLICATION FOR CREDIT ACCOUNT WITH FIREBOX AUSTRALIA PTY LTD
ABN: 75 116 370 793

Tick appropriate box:   Company Sole Trader / Partnership


Business Name / Company / Name of Applicant

Address of Registered Office  Delivery Address
Phone Phone




Contact for Account Queries      Mobile Phone 

Phone    Fax    Email


Contact for Sales Queries   Mobile Phone 

Phone   Fax    Email


ABN Number:  ACN Number:
(Partnership / Sole trader Business registered Number)
Date Applicant�s Business Commenced:
Period Under Current Management Years  Months 
Bank  Branch


Trade References (Three Required):

1. Name Phone Fax 
Address
2. Name Phone Fax 
Address
3. Name Phone Fax 
Address


Applicants agree to be bound by FIREbox Australia Pty Ltd terms and conditions of trading. Signatory below on behalf of Applicant declares the information on this form is true and correct.

By pressing submit, you also provide your consent for FIREbox to assess this credit application under the Privacy Act of 1988 and all current amendments. Any problems regarding this application please call us on (02) 4966 4465

Guarantee and Indemnity (where the Applicant is a corporation): In consideration for Firebox agreeing to provide credit terms to the abovenamed Applicant, I (Guarantor) personally guarantee the performance by the Applicant of its obligations to Firebox, as set out in the terms and conditions of credit sale below.


Printed Name

Position Held In Applicant

Amount of Credit Requested

Agree to our terms and Conditions.