Credit Application

Finalise Application

Choose Payment Method*

Direct Debit (No Admin Fees apply)
Scheduled Credit Card deduction (No Admin Fees apply – CC Surcharge still applies)
7 Day from Date of Invoice Account Terms ($12.50 + GST Admin Fee applies)

DIRECT DEBIT FORM

SCHEDULED CREDIT CARD DEDUCTION FORM

Name*

First Last

Company*

Phone*

Address*

Street Address Suburb State Post Code

Email*

Card Type*

Visa
Mastercard
AMEX

Cardholder Name*

Card Number*

Expiration Date

Security Code*

CVV on back of card

Authorisation Date*

By completing this form you authorise KIS Transport Australia Pty Ltd or KIS Corporate Pty Ltd to make automatic debits from your credit card each week.

By completing this form you give us permission to debit your account for the amount indicated every Friday for your invoice received on the previous Wednesday. This is permission for an automatic debit each week, and does not provide authorisation for any additional unrelated debits or credits to your account.

Company Name*

Bank Name*

Account Name*

BSB*

Account Number*

Address*

Street Address Suburb State Post Code

Phone*

Email*

Direct Debit Service Agreement*

I agree to the Direct Debit Service Agreement

Credit Card Agreement*

I agree to the Credit Card Agreement

Terms & Conditions*

I have read and I accept KIS Group of Companies Terms & Conditions

Consent*

I confirm that I have checked all information in this form and it is correct*

Signature*

Your Name :*

First Last

Date Signed

Your Email :*

CAPTCHA

Name

This field is for validation purposes and should be left unchanged.

ABN Details

Business Details

Accounts Contact Details

Operations Contact Details

Trade References :

Finalise Application

DIRECT DEBIT FORM

SCHEDULED CREDIT CARD DEDUCTION FORM

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