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Account Application

The Account Application is designed for new customers to gain access to our services and online portal. If you have an existing account with us but no login details, please e-mail info@domegarden.com

Business Details

The Applicant(s) Business/Trading Name Registered Company Name (if applicable)

ABN

ACN

Bus. Registration No

Business/Billing Address (not PO Box)

Suburb

State

Postcode

Shipping Address

Suburb

State

Postcode

Telephone Number

Fax Number

Email Address

Website

Principal Nature of Business

Corporate Structure

Proprietary Co. Public Co. Incorporate Body Trustee Sole Trader

Credit Account Details

Type of Account : Credit COD

Terms : 30 days from Invoice Date Other: Please State

How much do you estimate your monthly purchases will amount to?

Applicant's Financial Details

Business Premises : Owned Leased

Date Business Commenced :

Bank

Branch

Telephone

Trade/Business References

Names and addresses of three Trading References with whom you do regular account business:

Company Name(s)

Fax number(s)

Phone Number(s)

Company Name(s)

Fax number(s)

Phone Number(s)

Company Name(s)

Fax number(s)

Phone Number(s)

Proprietors/Owners

Name (1)

Date of Birth (1)

Address (1)

Driver's License No (1)

Name (2)

Date of Birth (2)

Address (2)

Driver's License No (2)

Additional Contacts

Store Manager

Name

Phone

Fax

Mobile

Purchaser

Name

Phone

Delivery Information

Commercial Loading Dock Available : Yes No

Forklift Available : Yes No

Delivery Time(s)

Store Hours of Operation

Monday Tuesday Wednesday Thursday Friday Saturday Sunday

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