Billing Address
Delivery Address (If Different from Billing Address)
Banker Information
INITIAL, 2nd AND 3rd ORDERS TO BE PRE-PAID IN FULL SUBSEQUENT ORDERS WILL BE PLACED ON ACCOUNT (CONDITIONS APPLIED) MAXIMUM CREDIT LIMIT IS AU$3,000 ACCOUNTS STRICTLY 30 DAYS FROM DATE OF INVOICE
By Submitting this form I/We declared the above information to be true and correct; I/We authorised Blossoms BH Wholesale Pty Ltd to check the references given on my/our credit and financial responsibility.