Eiffel Lubricants Credit Application

Credit Account Application | Eiffel Lubricants

Complete this form to apply for a credit account with Eiffel Lubricants, a company under Lectroni Australia.

Business/Company Legal Name

Trading Name

Company Type

Proprietary Company/Ltd Co

Trust

Sole Trader

Partnership

ABN (Australian Business Number)

ACN (Australian Company Number)

Description of Business/Industry

Years in Business

Registered Office Address

Postal Address (if different from Registered Office)

Business Phone Number

Business Email

Primary Contact Information

Contact Person Name

Position/Title

Contact Phone Number

Contact Email

Accounts Information

Accounts Payable Contact Name

Accounts Payable Email

Accounts Payable Phone Number

Average Monthly Purchases (estimate)

Purchasing Information

Purchasing Contact Name

Purchasing Email

Purchasing Phone Number

Director Details

Director 1

Director's Full Name

Director's Residential Address

Director's Email

Director's Phone Number

Director's Date of Birth

Driver's License Number (optional)

Trade References

Reference 1

Reference Company Name

Reference Contact Name

Reference Phone Number

Reference Email

Terms & Conditions

I/We have read and understood the Commercial Credit Terms of Trade and standard terms and conditions of sale

I/We understand that the trading terms are strictly thirty days from the end of month of delivery

I/We declare that the information provided is correct and agree that failure to comply with the Agreed Payment Terms may cause the withdrawal of credit facilities

I/We authorize Eiffel Lubricants to contact the above Trade References

Authorization

Authorizing Person's Name

Position/Title

Date

Electronic Signature

Please sign below using your mouse or touch screen

Eiffel Lubricants Credit Application

Primary Contact Information

Accounts Information

Purchasing Information

Director Details

Director 1

Trade References

Reference 1

Terms & Conditions

Authorization

Useful Links

Office Address

Email Address

Phone Number

Follow Us

Business Information

Contact Information

Address Information

Business Details