Credit Application Form

Account Number (Office Use Only)

Date

Company Name

Trading As (If Applicable)

ABN

ACN

Address

Street Address Street Address Line 2 City State / Province / Region Postal / Zip Code Country

Phone

Fax Number

Company Website

Nature of the Business

Date Business Commenced

Booking Contact Name

Booking Contact Email

Booking Contact Phone

Account Payable Contact Name

Account Payable Contact Email

Account Payable Contact Phone

Address for Accounts

Street Address Street Address Line 2 City State / Province / Region Postal / Zip Code Country

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

Please tick the following to Request DP Musson Pty Ltd to provide credit facilities and acknowledge that: [2]*

This account holder will be charged a transport account keeping fee of $5.50

Please tick the following to Request DP Musson Pty Ltd to provide credit facilities and acknowledge that: [3]*

This account holder will be charged a warehousing account keeping fee of $27.48 if applicable.

Please tick the following to Request DP Musson Pty Ltd to provide credit facilities and acknowledge that: [4]*

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

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