Villa Mondo Credit Application

VILLA MONDO PTY LTD 

49A HENRY STREET STEPNEY SA 5069 ABN: 58 082 501 755 

NEW ACCOUNT / CREDIT APPLICATION FORM Suppliers company name hereinafter called “The Supplier” NB. Only fully completed applications will be accepted – all pages must be signed and returned 

Full legal name of Applicant (“the Applicant’) 

Business/Trading name & address 

Postcode Phone No ( ) Fax ( ) Mobile No web address email address No of Years Trading Under Present Ownership ABN 

Business Type (please tick one) Sole Proprietor Partnership Company Trust 

Company / Trust Name 

ABN 

Registered Company Address (if different from above) 

Office No. ( ) Fax No. ( ) 

Bank Branch Account No 

OWNERS / DIRECTORS / GUARANTORS 

Name 

Owner Director Trustee 

(tick which ever box is applicable) 

Private address 

Postcode 

Home Phone ( ) 

Drivers Licence No Name Owner Director Trustee (tick which ever box is applicable) Private address Postcode Home Phone ( ) Drivers License No 

Any special instructions (please advise if delivery account address, etc. is different from above) 

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Applicants current Trade References must include phone numbers 

Name Address Area Code Phone/Fax 

1. 

( ) 

2. 

( ) 

3. 

( ) 

IMPORTANT NOTICE: PLEASE READ CAREFULLY BEFORE YOU SIGN PRIVACY ACT MATTERS and PERSONAL GUARANTEE / INDEMNITY. (Note if more than one Personal Guarantee/Indemnity is to be provided a separate application form must be completed and signed in each case) 

I, (insert full name) ………………………………………………………………………………………………………………………………………… 

Of (insert residential address) ……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………… 

Hereby apply on behalf of the Applicant for a Credit Account to be opened with the Supplier and, in consideration of the Supplier agreeing to open such a Credit Account, and to the full extent permitted by law: 

1. I warrant that I am a principal/director/trustee of the Applicant described on page 1 of the application and am authorised to make this Application on the Applicant’s behalf and to execute on behalf of the applicant the acknowledgements, consent and indemnity set forth in paragraphs 4, 5, 6, and 7 

2. I hereby personally guarantee the payment of all monies payable from time to time by the Applicant to the Supplier and also the due and full compliance by the Applicant with the Supplier’s Trading Terms set out on page 4 of this application, which I have read, understood and accepted. I further indemnify and agree to keep indemnified the Supplier in respect of any loss or expense incurred by the Supplier as a consequence of any failure by the Applicant to comply with the Supplier’s Trading Terms. This guarantee and indemnity shall continue regardless of any extension of time or other indulgence that may be granted by the Supplier to the Applicant from time to time. 

3. I warrant that the information provided on page 1 of the Application is true and correct. 

4. I acknowledge that the Supplier has furnished the Applicant with a complete copy of this Application and has advised the Applicant:- 

a. of the identities of the Supplier and Australian Gift and Homewares Association Limited (“the Association’) and how to contact each of them; and 

b. that the Supplier and the Association are able to gain access to the information supplied in the Application form; and 

c. that if there is any default by the Applicant in making payment to the Supplier, the information collected in the Agreement together with information as to the amounts claimed by the Supplier to be owing from time to time by the Applicant to the Supplier and legal or other steps taken by the Supplier to recover such amounts, all of which information and any related information is called “the default information”) may be furnished by the Supplier to the Association and the Association may disseminate all or any of the default information its members and their employees from time to time; and 

d. that the Supplier and the Association may therefore disclose all or any of the default information to other members of the Association and their employees; and 

e. that if the Applicant cancels it’s order for the supply of goods with the Supplier, the information collected in the Agreement and the fact of such cancellation (collectively called “the cancellation information”) may be reported by the Supplier to the Association and the Association may disseminate all or any of the cancellation information to its members from time to time; and 

f that the Supplier and the Association may therefore disclose the cancellation information to other members of the Association; and 

g. that the supply of goods to the Applicant may be refused if any particulars requested by the Supplier are not provided by the Applicant or if these terms are not agreed to by the Applicant. 

5. That the Applicant consents to the default information and the cancellation information being disclosed to the Supplier and the Association and to other members of the Association and otherwise being used in the manner referred to in paragraph 4. 

6. Applicant acknowledges that the Supplier and the Association have requested the Applicant to let the Supplier and the Association know immediately in writing if an any time the Applicant believes that the default information or cancellation information collected, used or disclosed by the Supplier or the Association is not accurate, complete and up to date. The Applicant acknowledges having been advised by the Supplier and the Association that the Applicant is entitled to access the default information and the cancellation information from time to time and require the Supplier and the Association to take all reasonable steps to ensure that all such information is accurate, complete and up to date. 

7. The Applicant and I each indemnify and will keep indemnified each of the Supplier and the Association against all action, demands, liabilities, proceedings, judgments or orders, claims, costs and expenses which the Supplier and the Association may suffer, incur or sustain (including any liability which the Supplier and /or the Association may incur to the Applicant) in connection with or arising in any way whatsoever as a consequence of:- 

a. the collection use or disclosure of the default information and / or the cancellation information as referred to in paragraph 4; and 

b. any such information not being accurate, complete and up to date. 

c. any misuse and loss of such information; 

d. any unauthorised access to, modification or disclosure of any such information; 

e. the failure to provide the Applicant or anyone on its behalf with access to such information and the opportunity to correct any errors; and 

f. the identification of any natural person in such information; and 

g. any interference with privacy within the meaning of the Privacy Act (C’wth) by the Supplier or the Association; and 

h. any breach of the said Act by the Supplier or the Association; and 

i. any breach by the Supplier or the Association of the National Privacy Principles set out in Schedule 3 of the said Act 

Signed:…………………………………………………………………………………………….. 

Personally and as principal for and on behalf of the Applicant 

Signature of Witness:.......................................................................................................... 

Name of Witness:…………………………………………………………………………………. 

(Use Block Letters) 

Dated………………………………………………………………………………