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Home
> Credit Application Form
Credit Application Form
Date of Application*
Type of business
Trade
Reseller
Caravan & Marine
Cylinder Testing
Name of Company/ Business
Company No.*
Postal Address*
Delivery Address*
Phone*
Mobile
Email (Main point of contact)*
Length of Time in Business
Desired Credit Limit Amount*
Bank and Branch
Purchasing Officer
Purchasing Email Address
Accounts Payable Officer
Accounts Email Address
Director #1 Individual Name*
Director #1 DOB*
Director #1 Home Phone*
Director #1 Residential Address*
Director #2 Individual Name (Optional)
Director #2 DOB (Optional)
Director #2 Home Phone (Optional)
Director #2 Residential Address (Optional)
Website account details
Username:*
(Must not contain spaces and must be less than 20 characters long)
Password:*
Confirm Password:*
We require three trade credit references and their contact phone numbers
Credit Reference #1*
Phone #1*
Credit Reference #2*
Phone #2*
Credit Reference #3*
Phone #3*
I submit the above details of my application for a credit account with your company and agree to the following conditions:
1.*
I acknowledge and accept the Galpro Stylex Terms & Conditions
2.*
Payment to be made 20th of the following month
3*
I hereby warrant my full authority to submit this account request and I accept responsibility in respect of any indebtedness arising in any way consequent hereupon
Name and Position*
Date*
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