Application for Company Credit Account

Please print and complete this form. Fax or mail to the following address:

                                                                                   COMSERV (No. 3070) Pty Limited Incorporated in N.S.W. Trading as
Standard Weighbridges Pty Limited.                                                                       Standard Auto Weigh
ABN 91 000 022 346                                                                                                                                                       ABN 53 003 909 420
14 Sammut Street                                                                                                  Telephone: (02) 9604 2677
Smithfield   NSW   2164                                                                                          Facsimile: (02) 9604 2599
Email: roger@weighbridges.com.au                                                           Website: www.weighbridges.com.au

APPLICATION FOR 30 DAY CREDIT ACCOUNT

COMPLETE IF A REGISTERED PUBLIC COMPANY OR PTY LTD:

Company:
Street Address:
State:                            Postcode:   
Email:   
Postal Address:
State:                            Postcode:   
ABN No:           ACN No:   
Phone:           Fax:           Mobile:   

COMPLETE IF AN INDIVIDUAL/PARTNERSHIP/REGISTERED BUSINESS NAME:

Surname:           Given Names:   
Street Address:
State:                            Postcode:   
Email:   
Postal Address:
State:                            Postcode:   
Phone:           Fax:           Mobile:   
Driver's Licence No:           State Where Held:   
Date Of Birth:                         Marital Status:   
Spouse's Name:                  Occupation:   

SMART CARD REQUEST
ALL APPLICANTS COMPLETE FOR 24HR WEIGHING 7 DAYS A WEEK:

Please supply   Smart Card(s) at $22.00 EACH (INCLUDING GST).

ALL APPLICANTS COMPLETE:

I/we agree to abide by the above Credit term and to advise Standard Weighbridges Pty Ltd of any change to the above details.
I/we also give permission for Standard Weighbridges Pty Ltd to check my/our commercial and consumer credit files with Baycorp Advantage.
If accounts are not paid within 60 days, collection agency costs maybe added to my/our account.

Signature of authorised person/applicant:

Date:

Position:

Name (Please Print):









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