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Oriental Merchant Pty Ltd

ABN 34 007 368 925

10 Westgate Drive, Laverton North, VIC 3026


Phone: (03) 9250 8133 Fax: (03) 9560 1316

ACCOUNT APPLICATION FORM


REGISTERED COMPANY/BUSINESS NAME: Salt n Spice Indian and Polynesian Supermarket
ABN/CAN 601677614
TRADING AS
TYPE OF BUSINESS:(Tick1): SOLE PROPRIETOR PARTNERSHIP PROPRIETARY COMPANY
REGISTERED ADDRESS 7/109 Grand Plaza Drive Browns Plains 4118
BUSINESS ADDRESS Same As Above
REGISTRATION DATE: 6/09/2014
NATURE OF BUSINESS Retail
AUTHORIZED CAPITAL STOCK:: .:.PAID UP CAPITAL
PROPRIETOR(S)/DIRECTOR(S) CONTACT NO. BIRTHDATE/ D.LICENSE #:. PERSONAL ADDRESS:

1)Shabin Shaista Dean (0433642525) 02/06/1993 13/45-47 Defiance Road Woodridge 4114
...
2) . ___/___/______-.............. ..
...
3) . ___/___/______-.............. ..
. ...
SECRETARYS FULL NAME CONTACT NO. BIRTHDATE/ D.LICENSE #:. PERSONAL ADDRESS:

. ___/___/______-.............. ...
. ...
DELIVERY ADDRESS 7/109 Grand Plaza Drive Browns Plains 4118
POSTAL ADDRESS: Same as Above
CONTACT0433642525; 0433068181 EMAIL: saltnspicesupermarket@gmail.com PH/FAX: 0738001950
ORIENTAL MERCHANT PTY LTD ACCOUNT APPLICATION
Page 2 of 2

ACCOUNT APPLICATION (Continued)


TRADE REFERENCES: CONTACT PHONE
1) ..
2) ...
3) ...
CREDIT LIMIT REQUEST: $........................ TERMS: ...............................................
Terms and Conditions
I/We hereby confirm we have read, accepted and agreed to all the terms and conditions specified below:
1. Credit facility is only available upon receipt of signed acceptance offered by Oriental Merchant Pty Ltd
(Oriental Merchant).
2. Accounts must be settled in full as they fall due within the trading terms granted by Oriental Merchant
stipulated on statement and/or invoice.

3. Default in payment will automatically revert account to COD.


4. Ownership of the goods sold belongs to Oriental Merchant until full settlement of invoice. The risk of loss
or damage to the goods shall be entirely at our risk upon delivery of the goods to us.
5. No claim of any kind shall be entertained by Oriental Merchant after seven (7) days from the date of
delivery.
6. Acknowledgment/Receipt of goods is proof of delivery.
I /We agree to be responsible to Oriental Merchant for all balances which are due or may be from the
time hereafter owed by the applicant, for goods and services supplied by Oriental Merchant to the
applicant. Interest on the applicants overdue payments, costs incurred by Oriental Merchant in the
course of recovering and/or enforcing judgments for monies due and payable by the applicant are fully
borne by the applicant.

Shabin Shaista Dean


Name & Signature of Proprietor/Partner/Director Name & Signature of Proprietor/Partner/Director
Date 24/02/2015
PRIVACY STATEMENT: Oriental Merchant Pty Ltd (Oriental Merchant) is committed to protecting your privacy and the
confidentiality and security of personal information provided by you to us. The information you provide is necessary to process your
application and will be stored as record and profile information. The information provided by you will be used to contact you, your
banker, and your referees. The information in this application form will be furnished to credit organizations for credit checks, and in the
event of your default and non compliance with the default notice, may be disclosed to a debt collection agency, and the overdue
account published with a credit reporting agency. Please contact Oriental Merchants Privacy Office if you would like to access or
update information we hold about you or your company. For more information on Oriental Merchants Privacy Statement, visit our
website at www.oriental.com.au

AUTHORITY IN RELATION TO CREDIT INFORMATION


I/We authorise Oriental Merchant to obtain a credit report containing information about me/us from a credit reporting agency, and any
information about my/our commercial creditworthiness from my/our banks and referees, for the purpose of assessing my/our application
for commercial credit. I/We authorise Oriental Merchant to disclose my/our credit information to other credit providers and credit
reporting agencies. I/We authorise Oriental Merchant to disclose my/our credit information to its collecting agents including debt
collection agencies and its solicitors to enable collection of my/our overdue payments. I/We authorise Oriental Merchant to notify a
credit reporting agency if I/ we become overdue in making payments and list me/us in default.

Signature of Proprietor/Partner/Director
Print Full name: Shabin Shaista Dean
Date: 24/02/2015
PLEASE EMAIL COMPLETED FORM TO: For Internal use only:
NEW ACCOUNTS Sales Rep: .
ORIENTAL MERCHANT PTY LTD
10 WESTGATE DRIVE Sub Group:.
LAVERTON NORTH VIC 3026
Or Fax: (03) 92508111 Price Code:.

For Internal use only:


Sales Rep:_______________
Subgroup:_______________
Price code:_______________
Replacement of: __________