New account application

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By applying for account with Blossoms BH Wholesale Pty Ltd, the applicans(s) agree(s) to terms and conditions of the Company's standard contract.

Business Name *

Trading Name *

ABN *

Billing Address *

Delivery Address *

Phone Number *

Fax

Email *

Owner/Director's Name

Mobile

Fax

Address

Entity type *

Pty Ltd

General Partnership

Limited Partnership

Corporation

Sole Trader

Other:

Name and address of Bank *

Account Number *

BSB *

Trade Reference #1

If you have any trade reference, please leave your reference's Company name, Phone number and Email here.

Trade Reference #2

If you have any trade reference, please leave your reference's Company name, Phone number and Email here.

Trade Reference #3

If you have any trade reference, please leave your reference's Company name, Phone number and Email here.

Statement by applicant(s) for credit *

1. Access to Consumer Credit Information for a Commercial Credit Application (Section 18k(1)(b) Privacy Act 1988). As part of its normal credit assessment procedures, I consent to Blossoms BH Wholesale Pty Ltd obtaining a credit report about me. 2. Exchanging information with other Credit Providers (Section 18N(1)(b) Privacy Act 1988) I agree to Blossoms BH Wholesale Pty Ltd obtaining personal information about me from other credit providers, whose names I may have provided to Blossoms BH Wholesale Pty Ltd or that may be named in a credit report, for the purpose of assessing my application for commercial credit.

I have read and understand Blossoms BH Wholesale Pty Ltd Terms and Conditions and Guarantee and Indemnity.

Required

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