Credit Application Credit Application Form Company Information Registered Business Name * Please enter your Registered Business Name Account Number * Please enter your Account Number Contact Person * Please enter the Contact Person Email Address * Please enter your Email Address Credit Information Current Credit Terms * PrepaidCOD7 Days14 Days30 Days Required Credit Terms * 7 Days14 Days30 Days Other Terms Required Credit Limit Required * Please enter the Required Credit Limit Name of Owner/Principal/Partner * Please enter the name of the Owner/Principal/Partner Phone Mobile Phone * Please enter the Mobile Number of the Owner/Principal/Partner Email Address Trade Reference 1 Organisation or Business Name * Please enter the name of the Organisation or Business Name Address * Please enter the Address Phone * Please enter the Phone Number Email Address * Please enter the Email Address Type of account held with this Referee * (e.g. 14 day credit) Please enter the Type of Account held Credit Limit * Please enter the Credit Limit Length of time you have held this account * Please enter the length of time you have held the account Trade Reference 2 Organisation or Business Name * Please enter the name of the Organisation or Business Name Address * Please enter the Address Phone * Please enter the Phone Number Email Address * Please enter the Email Address Type of account held with this Referee * (e.g. 14 day credit) Please enter the Type of Account held Credit Limit * Please enter the Credit Limit Length of time you have held this account * Please enter the length of time you have held the account Trade Reference 3 Organisation or Business Name * Please enter the name of the Organisation or Business Name Address * Please enter the Address Phone * Please enter the Phone Number Email Address * Please enter the Email Address Type of account held with this Referee * (e.g. 14 day credit) Please enter the Type of Account held Credit Limit * Please enter the Credit Limit Length of time you have held this account * Please enter the length of time you have held the account Preferred Payment Method Direct Deposit Visa/Mastercard American Express Note: 1.5% Surcharge applies Note: 3% Surcharge applies We collect your personal information so we can assess your application for a Wholesale Horticultural Group P/L Credit Account. We will be unable to assess your application or provide you with access to a Business Credit Account without all or part of the personal and other information we require. In order to assess your application for credit you hereby consent to your personal information being disclosed to third parties. This may include disclosure to credit reporting agencies (e.g. Equifax), companies who provide commercial credit references, people you authorise us to contact in connection with this application or any approved Business Credit Account, mercantile agencies and other companies who provide outsourced services to us. Subject to certain exceptions allowed by law you may request access to your personal information while it is stored by us. We will give you reasons where we deny access. We will not share your information with any Marketing or unmentioned third parties. We may use your personal information to tell you about our promotions, products or services we think may be of benefit to you. Agreement * I have read, understand and agree to the Condition of this Application Form and WHG Terms of Trade Yes Please tick that you agree to our Terms of Trade True and Correct Information * I declare that the information provided by me in this application is true and correct Yes Please tick that everything is True and Correct Name * Please enter your name Signature * Please sign in the box below Clear Signature Or if you have trouble signing in the box above, you can upload a photo of your signature or a form of identification that includes a signature, eg your drivers license. Upload Photo Please sign your name Title * eg. Director, Partner, etc. Please enter your title Read our Privacy Policy Having trouble registering? please email for assistance.
