Client Information Form - Casa Del Desserts



CUSTOMER INFORMATION FORM

Please complete all sections and read the Terms and Conditions of Trade overleaf or attached.

|Customer’s Details: ( Individual ( Sole Trader ( Trust ( Partnership ( Company ( Other: |

|Full or Legal Name: |

|Delivery Address: |State: |Postcode: |

|Special Delivery Instructions: (E.g. Loading Docks Etc) |

|Billing Address: |State: |Postcode: |

|Email Address: |

|Phone No: |Fax No: |Mobile No: |

|Mailing/Newspaper List: ( Yes ( No |Calling List: ( Yes ( No |

| |

|Personal Details: (please complete if you are an Individual) |

|D.O.B. |Driver’s Licence No: |

| |

|Business Details: (please complete if you are a Sole Trader, Trust, Partnership, Company or Other – as specified) |

|Trading Name: |

|ABN: |ACN: |Date Established (current owners): |

|Contact Person: |Phone No. |

|Nature of Business: |

|Directors / Owners / Trustee: (if more than two, please attach a separate sheet) |

|(1) Full Name: |D.O.B. |

|Private Address: |State: |Postcode: |

|Driver’s Licence No: |Phone No: |Mobile No: |

|(2) Full Name: |D.O.B. |

|Private Address: |State: |Postcode: |

|Driver’s Licence No: |Phone No: |Mobile No: |

|Account Terms: Cash On Delivery |

|New Customers are required to pay cash on delivery for a minimum of three (3) months from their first purchase order. |

|After three (3) months if Customers would like to apply for a Credit Account, please contact the office via email at info@.au and request an |

|application form and await approval from the account’s manager. |

|Account Contact Name: |Accounts Phone Number: |

|Accounts Email Address: |Invoices to be emailed: ( Yes ( No |

I certify that the above information is true and correct and that I accept the supply of credit by Casa Del (if applicable). I have read and understand the TERMS AND CONDITIONS OF TRADE (overleaf or attached) of Casa Del Australia Pty Ltd which form part of, and are intended to be read in conjunction with this Customer Information Form 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.

SIGNED (CUSTOMER): SIGNED (CASA DEL):

Name: Name:

Position: Position:

WITNESS TO CUSTOMER’S SIGNATURE:

Signed: Name: Date:

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Casa Del Australia Pty Ltd

ABN: 50 127 620 339

5 Faversham Street, Marrickville, NSW 2204

Phone: (02) 9550 5982 • Fax: (02) 9550 6663

Email: info@.au

Web: .au

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«LegalName» T/A «CustomerName»

ABN: «ABN»

«Address1», «Address2», «Address3» «State» «PostCode»

Phone: «Phone» • Fax: «Fax»

Email: «TOTEmailAddress» • Web: «Website»

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Protected by EC Credit Control – Credit Management Specialists

© Copyright 1999 - 2019 – #«Code»

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