Credit Application Form

Please complete all fields below. All orders are paid online at the time of placing the order via credit card.

Client — Billing Information

Full Legal Name of Applicant / Company / Partnership *

Trading As

Business Entity Type *

Limited Company Partnership Sole Trader Other

Company ABN *

Electrical Contractor / Work Licence Number

Billing Address *

City *

State *

Postcode *

Contact Email *

Contact Phone *

Contact Person Name *

Position *

Delivery Information Same as billing information

Business Delivery Name *

Delivery Address *

City *

State *

Postcode *

Contact Email *

Contact Phone *

Contact Person Name *

Position *

Acceptance & Acknowledgement

By submitting this application, I/we confirm that:

All information provided is true and correct.
I/we have read and agree to the Terms and Conditions.
All orders are paid online at the time of placing the order via credit card.

Director / Authorised Signatory Position *

Date *

I agree to the Terms and Conditions *