APPLICATION FOR CREDIT

TRADING NAME ________________________________________________

BUSINESS ADDRESS ____________________________________________

POSTAL ADDRESS ______________________________________________

PHONE (   ) ______________________ FAX (  ) ______________________

PROPRIETORS

NAME ________________________________________________________

ADDRESS _____________________________________________________

                 __________________________ PHONE ____________________

NAME ________________________________________________________

ADDRESS _____________________________________________________

                __________________________ PHONE ____________________

ACN NO _____________________  ABN NO __________________________

BANK    _____________________  BRANCH __________________________

BUSINESS REFERENCES

Company Name                                       Phone No.                Monthly Estimated Expenditure

__________________________      (    ) _____________         $ ______________

__________________________      (    ) _____________         $ ______________

__________________________      (    ) _____________         $ ______________

I, the undersigned, apply for the credit for the supply of goods on 30 DAY NETT terms, and warrant the correctness of the above information.  I also give authority to check relevant information as stated above.

SIGNED  _________________________________________      DATED _____________