Reseller Application Form – Blossoms BH Wholesale

Reseller Application

Account Application Form

If you are a human and are seeing this field, please leave it blank.

Fields marked with an * are required

Company/Business Name *

Trading Name *

ABN

Owner/Director *

Email Address *

Contact Number *

Fax Number

Billing Address

Street Address *

City / Suburb *

Post Code

Country

Delivery Address (If Different from Billing Address)

Street Address

City / Suburb

Post Code

Country

Banker Information

Bank Name *

Bank Address *

BSB Number *

Account Number *

Reference #1 Company *

Reference #1 Phone *

Reference #1 Email *

Reference #2 Company *

Reference #2 Phone *

Reference #2 Email *

Reference #3 Company *

Reference #3 Phone *

Reference #3 Email *

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.