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Credit Application
1
ABN Details
2
Business Details
3
Contact Details
4
Trade References
5
Finalise Application
ABN Details
ABN :
*
Entity Name:
*
Business Type
*
Pty Ltd
Ltd
Sole Trader
Trust
Name of the Trustee
*
Is your Trading Name the same as your Entity Name?
*
Yes
No
If 'No', please state your Trading Name below:
*
Please enter an active ABN to proceed
Business Details
Address
*
Street Address
Suburb
State
Post Code
Name of Director (s)
*
One entry per line
Is your company part of a co-operative or buying group?
*
Yes
No
If 'Yes', which co-operative/buying group do you belong to?
*
HBT
Synergy
MME
Monthly Credit Limit
*
Annual Freight Spend
*
Freight Profile
*
Satchels
Cartons/Boxes
Skids/Pallets
Ugly
Full Loads
Domestic
International
Other
How did you hear about KIS?
*
KIS Sales Rep
Referral
Website via Search
Website directly
Referral
*
Please enter the name of the business that referred you to KIS
Who's your KIS Sales Rep (Type Name)
*
Accounts Contact Details
Contact Name
*
Phone :
*
Email
*
Allow access to invoices via the iCONSIGNIT Platform?
*
Yes
No
Operations Contact Details
Contact Name
*
Phone :
*
Email
*
Allow access to invoices via the iCONSIGNIT Platform?
*
Yes
No
Please note that the contacts listed above will automatically be added to the KIS electronic mailing list to ensure receipt of any important communications
Trade References :
Transport companies will not be accepted
1. Full Name
*
First
Last
Company Name
*
Telephone
*
Email
*
2. Full Name
*
First
Last
Company Name
*
Telephone
*
Email
*
3. Full Name
*
First
Last
Company Name
*
Telephone
*
Email
*
Finalise Application
Choose Payment Method
*
Direct Debit (No Acc. Management Fees Apply) *To qualify for no Acc. Management Fees you must spend a minimum of $200p/w. Acc. Management fees will be automatically applied during any account period where the minimum spend is not met.
Scheduled Credit Card deduction (No Acc. Management fee – CC Surcharge still applies) *To qualify for no Acc. Management Fees you must spend a minimum of $200p/w. Acc. Management fees will be automatically applied during any account period where the minimum spend is not met.
7 Day from Date of Invoice Account Terms ($12.50 + GST Acc. Management 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
*
MM slash DD slash YYYY
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
Your Name :
*
First
Last
Your Email :
*
CAPTCHA
Email
This field is for validation purposes and should be left unchanged.
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