Application for 30 Day Account

ABN: 57134848454

Please get in touch if you have any questions:

Phone: +61 2 6742 0024

Title of Account

Address to which accounts are to be mailed

Telephone Number

Email

Full name (s) of applicants:

Residential address

Own/Rent/Landlord

Period of residence at above address

Occupation

Permanent/Casual since:

Name and address of employer

Identification eg. Drivers License no.

Trade References (3 required)

Important:

By submitting this form, you agree to the following:

Conditions of agreement to establish credit facilities: I am fully aware that Karen Carter Chemist trading terms are strictly 30 days. I am also aware of and agree to pay fees or charges which may be added to my account if in arrears as a result of me not having paid such account on the due date. I also agree to pay all legal expenses, charges and commissions incurred as a result of my unpaid account having been collected through the efforts of Karen Carter Chemist legal collection process.

Please correct the errors above and try again.

ABN: 57134848454

Please get in touch if you have any questions:

Phone: +61 2 6742 0024