Credit Application Form
Fill below to open an account with Rush Express

Account Number (office use only)
Date

Company Name
Trading as (if applicable)
ABN
ACN
Address
Street AddressAddress Line 2CityState / Province / RegionZIP / Postal CodeCountry
Phone
Fax Number
Your Company Website
Nature of the Business
Date Business Commenced
Booking Contact Name
Booking Contact Email
Booking Contact Telephone
Accounts Payable Contact Name
Accounts Email
Accounts Payable Contact Number
Address For Accounts
Street AddressAddress Line 2CityState / Province / RegionZIP / Postal CodeCountry
Average Weekly Spend ($)
1. Trade Referencee & Contact Details
2. Trade Referee& Contact Details
Please tick the following to Request DP Musson Pty Ltd to provide credit facilities and acknowledge that: *
Accounts are rendered each seven (7) days and are payable strictly fourteen (14) days net
The undersigned accepts that a 15 % fuel levy is applied to this account & may alter from time to time.
This account holder will be charged a transport account keeping fee of $5.50
This account holder will be charged a warehousing account keeping fee of $27.48 if applicable.
There will be no Insurance cover unless requested in writing and agreed by DP Musson Pty Ltd.
Terms & Conditions*
By ticking yes I fully understand and accept the terms and conditions of creating a credit account with Rush Express
Name
This field is for validation purposes and should be left unchanged.