Online Form - SWEK Debtor Account Application

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You have the ability to save this form and complete it at a later date. An email will be generated and sent to the specified address.

Email Address:

Password:

There is no way to resend or recover your password, please write it down.

Note: Incomplete forms are kept for a period of 2 day(s), after this time the system will automatically delete your response.

Business Details

Registered Name*

Trading As*

ABN/ACN Number*

Years Trading*

Trading Address

Street Address:

City:

State:

Post Code:

Country:

Postal Address

Postal Address:

City:

State:

Post Code:

Country:

Credit Limit Requested*

Contact Details

Contact Name*

Contact Number - BUSINESS*

Contact Number - AFTER HOURS*

Contact Number - MOBILE

Email*

Would you like to receive invoices via email?

YesNo

Referees

Please supply the names of the three referees – businesses that can tell us about your trading history (Not utilities, lawyers, accountant, credit cards or banks)

Referee 1 Name*

Referee 1 Contact

Referee 2 Name*

Referee 2 Contact*

Referee 3 Name*

Referee 3 Contact*

Declaration

I certify (as signatory to this application) that the above information is true and correct and that I am authorised to make this application on behalf of the ‘Debtor’. I acknowledge and accept the Terms and Conditions as listed below:

Agrees to pay the amount on Shire invoices on or before 35 days from date of invoice.
Acknowledges that after 35 days penalty interest will accrue at the prescribed rate on all outstanding amounts.
Consents to the Shire performing a credit reference check and making other enquiries to enable the Shire to decide whether or not to grant credit.
Acknowledges that all fees incurred by the Shire in relation to debt collection will be on-charged to the debtor.
Agrees to advise the Shire of any changes to details (i.e. phone number, address, email address etc.).
Accepts that the Shire may withdraw or suspend this credit facility if the debtor does not pay an invoice by the due date.

Please type your name below to signify that you agree that all information given above is true and correct at the time of submission*

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