Credit Application

This is an application for commercial credit submitted to Just Earth, for consideration based on information supplied. The submission and/or completion of this application are not to be considered an offer of credit or acceptance of the applicant for provision of credit facilities.

Applicant Company Details

Full Company Name

Phone Number

Contact Email

Fax Number

Trading Name

ACN/ABN

Internal Accounts Payable Contact Name and Number

Office Address

Postal Address

Invoicing Method

Mailed to Postal Address Emailed (please supply two email addresses)

Invoicing Email 1

Invoicing Email 2

Requested Credit Terms

Amount of Credit

Credit Terms

Principal Business Activity

External Accountants’ Details

Accountants

Accountants' Address

Current Trade References

Reference 1 Name

Reference 1 Phone Number

Reference 2 Name

Reference 2 Phone Number

Reference 3 Name

Reference 3 Phone Number

The Applicant herein authorises Just Earth to contact the Accountant, Financial Institution and Trade Reference referred to above to obtain credit information in assessing this application for credit and/or the ongoing provision of credit.

Notification Of Change In Ownership

The applicant will notify Just Earth by email no later than fourteen days prior to any proposed changes of ownership of Registered particulars, of alteration to or addition to shareholding or to the applicant’s internal structure which may a ect the applicant’s capacity to honour agreed trading terms with Just Earth.

Acceptance Of Terms & Conditions

I certify that the information contained in this application for a commercial credit account is to the best of my knowledge and belief and correct in every detail. I have read and understood the terms and conditions set out above, and hereby acknowledge and accept on behalf of the applicant terms and conditions. The applicant agrees to conduct all trading in accordance with those terms and conditions.

Full Name

Position

The signatory warrants that he or she is authorised on behalf of the applicant to submit this application to Coastal Midwest Transport and to credit terms and

I agree and accept the Terms & Conditions