COMPANY DETAILS

Company Trading Name:

Registered Company Name:

Registered Business Name:

ABN:

Business Address:

PROPRIETORS / DIRECTORS

Name :

Address:

Private Telephone:

Drivers Licence #:

Email:

Name :

Address:

Private Telephone:

Drivers Licence #:

Email:

BUSINESS REFERENCES

1# Company Name:

Tel:

1# Contact:

Fax:

2# Company Name:

Tel:

2# Contact:

Fax:

3# Company Name:

Tel:

3# Contact:

Fax:

4# Company Name:

Tel:

3# Contact:

Fax:

I/We give the above names and details of references of whom the customary trade enquiry may be made.

COMPANY PROFILE

Summary of Business Activities:

No of employees:

No. of years trading

Years

Months

We expected maximum amount of credit required monthly:

Industry:

Conference Promotional Office Supplies Security

Other: Please specify:

Industry Associations:

APPA MIAA SCBV ASIAL

Other: Please specify:

BANKING DETAILS

Name of Bank:

Branch:

CONTACT DETAILS

Contact Name:

Tel:

Email:

Accounts Payable Contact:

Tel:

Email:

I/We being Proprietor(s) / Director(s) of the above applicant's Business / Company and in consideration of credit being granted to the above applicant's Business / Company hereby jointly and severally guarantee payment of all debts incurred by our Business / Company to Lanyards Australia Pty Ltd. I/We agree that this guarantee is a continuing one and that our liability hereunder will not be in any way waived or affected by any time or indulgence granted by the Creditor to the Business / Company.

I/We understand and agree that to be an approved Reseller Partner on credit facilities I/we must spend a minimum of $5,000 per financial year. Failure to meet this criteria will result in Reseller Partner Status on credit account being revoked.

I/We agree to adhere to the General Terms and Conditions of Sale, as specified in Schedule 1 of this agreement.

Proprietor / Director Name:

Date:

Please be advised that completion of this form does not automatically entitle you to become an official OZID Reseller Partner. Your application will be processed within 5 working days and in the event of a successful application, a Business Development Manager will contact you to formalise credit and trading terms.