Please complete the form below (Fields marked * are required)
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*Company/Trading Name:
*ABN:
*Business Address:
Postal Address: As Above
*Phone:	Mobile:
Fax:	*Email:
Web Site:
*Full Name of Proprietor(s): 1. 2.
*Address of Proprietors: 1. 2.
*Name of Bank: *Bank Branch: *Account Name:
*Preference For Payment: Cheque, Credit Card, Eft/Direct Deposit
*Please furnish the name and telephone number of two business references: Reference 1: Reference 2:
*I/We wish to make an application to open a credit account with Cotton On Creations in accordance with the following conditions: Terms are strictly nett 30 days from the date of invoice Any accounts which remain unpaid after 45 days shall thereafter be shipped on a C.O.D basis only. Credits will only be given if this office is notified of the reason within 10 days of delivery. I/We agree that any costs incurred in the collection of overdue accounts shall be met by me/us.