Apply for a Workspace Credit Account

Company Details

Company Name(Required)

Company No.(Required)

Trading Name (If different from above)

Type of Business(Required)

Date Incorp. (current owners):(Required)

Other

Nature of Business(Required)

GST No (if applicable)

Physical Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Billing Address (if different from physical address)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Contact Details

Primary Contact Name(Required)

Position(Required)

Email(Required)

Phone(Required)

Credit Details

Account Terms(Required)

Estimated Monthly Spend

Credit Limit Required

Other

Billing Contact(Required)

Billing Phone No(Required)

Purchase Order Required

Accounts to be emailed

Directors / Owners / Trustee

List(Required)

Full Name

D.O.B.

Email

Phone

Address

Driver’s Licence No

Trade References - please provide companies that are willing to do trade references (min 2)

References(Required)

Reference 1

Address

Phone / Fax / Email

I certify that the above information is true and correct and that I am authorised to make this application for credit. I have read and understand the TERMS AND CONDITIONS OF TRADE (overleaf or attached) of Office Interiors Limited (including Int.workspaces a division thereof) which form part of, and are intended to be read in conjunction with this Credit Account Application and agree to be bound by these conditions. I authorise the use of my personal information as detailed in the Privacy Act clause therein. I agree that if I am a director/shareholder (owning at least 15% of the shares) of the Customer I shall be personally liable for the performance of the Customer’s obligations under this contract.

I agree to the Terms and Conditions(Required)

I agree

Name(Required)