General Cargo Credit Account Application Form

BUSINESS CONTACT INFORMATION

Title:

Company name *:

Phone *:

Fax:

E-mail *:

Registered company address *:

City *:

Region:

Postal Code:

Date business commenced *:

Organisation type:

Please provide your organisation type:

BUSINESS AND CREDIT INFORMATION

Primary business address *:

City *:

Region:

Postal Code:

How long at current address? *:

Phone *:

Fax:

E-mail *:

Bank name:

Bank address:

Phone:

City:

Region:

Postal Code:

Type of account:

Account number:

BUSINESS/TRADE REFERENCES

Company name *:

Address *:

City *:

Region:

Postal Code:

Phone *:

Fax:

E-mail *:

Type of account:

Company name *:

Address *:

City *:

Region:

Postal Code:

Phone *:

Fax:

E-mail *:

Type of account:

Company name *:

Address *:

City *:

Region:

Postal Code:

Phone *:

Fax:

E-mail *:

Type of account:


AGREEMENT

  1. All Final invoices are to be paid by 20th Month following & Disbursement Invoices to be paid 7 days from invoice date.
  2. Claims arising from invoices must be made within seven working days.
  3. By submitting this application, you authorize Jacanna Customs & Freight to make inquiries into the banking and business/trade references that you have supplied.

Please tick this box to confirm that you have read and accept Jacanna Customs & Freight's Terms and Conditions in conjunction with the above points.

SIGNATURES

Title *:

Name *:

Date *:

Title:

Name:

Date: