Adelaide
11 - 13 Opala Street, Regency Park, South Australia 5010 Australia
Brisbane
14/65 Christensen Road, Stapylton, Queensland 4207 Australia
Phone: (08) 8243 0233
International Phone: + 61 8 8243 0233
Email: [email protected]
Fax: (08) 8243 1744
International Fax: + 61 8 8243 1744
Internet: www.sienafoods.com.au
Registered
Company Name:
Trading
Name:
COD
CUSTOMER
INFORMATION
FORM
Physical
Address:
Postal Address:
Please
Indicate: Company Partnership
Sole
Prop
Trustee Co
If a Trust – Name of Trust:
Date of Trust Deed:
Telephone:
Accounts
Payable:
Email:
Purchase
Contact:
Email:
Mobile:
Order
Number Required:
YES NO
Full name and residential addresses of
all the Directors/Partners/Proprietors:
Name
Residential
Address
Driver’s License No.
Date of Birth
Name
Residential
Address
Driver’s License No.
Date of Birth
•
Siena Foods
Pty
Ltd reserves the right
to
vary, suspend
or
withdraw
credit
facilities at
any
time
without
notice.
•
Special Note: if the Account holder acts as, or is part of, a Trust/Nominee company then the provision of personal guarantee/s from the
Trust Beneficiary/Beneficiaries may be required.
** CUSTOMER TO SIGN ACKNOWLEDGING GOODS ARE TO BE PAID FOR AT TIME OF DELIVERY/PICKUP **
………………………….................... ……………..………………………….. …………………………
Print name Signature Dated
OFFICE USE ONLY
Letter Sent Dated…...…………..
SALES REP I.D: APPROVED: DECLINED: SHORT CODE: ………………………
S
I
E
N
A
F
O
O
D
S
P
T
Y
L
T
D
ABN:
ACN: