Customer Account Application Please enable JavaScript in your browser to complete this form. - Step 1 of 41. Business DetailsCompany or Business Name: *Business Details: *Sole TraderPartnershipCompanyOtherABN: *ACN:Trading as: *Parent Company Name (If applicable):ABN: *ACN: *Street Address for Deliveries *Post Code: *Loading Dock: *YesNoContact Person (Purchasing) *Telephone *Email *Contact Person (Accounts) *Telephone *Email *Next2. Details of Sole Trader/ Partners/ Directors or TrusteesFull Name *Date of Birth *Drivers License No. *Residential Address *Telephone *Post Code *Full NameDate of BirthDrivers License No.Residential AddressTelephonePost CodeFull NameDate of BirthDrivers License No.Residential AddressTelephonePost CodeNext3A. Have any of the business principals (directors / partners / trustees or proprietors) been bankrupt or used Part X of the Bankruptcy Act?3A. Have any of the business principals (directors / partners / trustees or proprietors) been bankrupt or used Part X of the Bankruptcy Act? *YesNoIf yes, please provide details: *3B. Has the applicant or anyone associated with the applicant been involved in the management or control of a business which has been wound up, had a receiver, administrator or liquidator appointed or entered into a scheme for the benefit of creditors?3B. Has the applicant or anyone associated with the applicant been involved in the management or control of a business which has been wound up, had a receiver, administrator or liquidator appointed or entered into a scheme for the benefit of creditors? *YesNoIf yes, please provide details: *Next4. Brief Description of Business *5. How Long Has Your Business Been Trading? *6. Anticipated Spend Fruit & Veg (Weekly): *7. Preferred Payment Method: *Electric Fund TransferChequeCashCredit Card8. Trade/Business ReferencesUnable to provide trade references *Unable to provide trade referencesCompany *Contact Person *Email *CompanyContact PersonEmailCompanyContact PersonEmail9. How did you hear about us / who referred you to us?How did you hear about us / who referred you to us? *Agreement *I certify that the above information is true and correct and that I am authorised to make this application for credit. I have read and understood the Terms & Conditions of Trade and Services Agreement of Sawgrass Pty Ltd t/as Velluti’s – The Fruit and Veg Company (located on Velluti’s website) which form part of and are intended to be read in conjunction with this Customer Account Application and agree to be bound by these conditions. I authorise the use of my personal information as detailed in the Privacy Act clause therein. I agree that if I am a director/shareholder (owning at least 15% of the shares) of the Client I shall be personally liable for the performance of the Client’s obligations under this contract.Full Name *Position *Signature *Sign using mouseUpload scanned signatureSignature *Clear SignatureUpload Signature * Click or drag a file to this area to upload. Submit
