Form (Credit App) Pure and Healthy Credit Application Business Details Name ABN Proprietor(s) Name Mobile Name Mobile Trading Address Street address Suburb Postcode Billing/Mailing Address Mailing address Suburb Postcode Accounts Dept Contact Phone Mobile Email Credit References Reference 1 Company Phone Contact Reference 2 Company Phone Contact Trading Terms Trading terms will be NET 15: Payment is due 15 days from the date of the invoice. We would appreciate your cooperation with this time frame. If there are any difficulties with payment please contact us immediately. Outstanding accounts that are handed to a third party to be recovered will incur additional recovery fees. Signature Date