Fillable Customer Account Application (Australian Broadcasting Corporation)

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Customer Account Application (Australian Broadcasting Corporation)

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The Customer Account Application (Australian Broadcasting Corporation) form is 4 pages long and contains:

  • 16 signatures
  • 30 check-boxes
  • 111 other fields

Country of origin: AUSTRALIA
File type: PDF

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Trading Terms
Please estimate your monthly spend
<$1,000$ 1,000-$5,000
$5,000-$10,000 >$10,000
Please tick which Trade Credit Facility you wish to
apply for
Cash Account: all orders must have conrmation of
payment before dispatch.
Direct Debit:
Bank account – Direct transfer from nominated
bank account on the 4th of each month and
receive 0.5% discount off your balance.
Credit account – Direct payment from nominated
credit card on the 4th of each month and receive a
0.9% + GST discount in our merchant fee.
Trading Account:
S90 Community Pharmacy (Retail Pharmacy
Customer); 25 day credit facility, all invoices due
and payable 25 days from end of month.
All other Trading Accounts; 30 day credit facility, all
invoices due and payable from invoice date.
Other
Please tick which CH2 services you would like to
receive
Access to our online ordering platform - CH2 Direct
Access to our electronic invoice portal - CH2 Link
Customer Details
Company name
Trading name
ABN ACN
Contact Name
Contact Role
Phone
Acting as trustee
of a trust
Email
Please complete all elds in capital letters and ensure you sign this form before returning. Please fax or email your completed
application to CH2 accounts department.
This account is non transferable without the prior written consent of CH2. It is the responsibility of the Customer to notify CH2 of any
changes of ownership 14 days prior to any such change.
Nature of Business (please tick)
Public Hospital S 94 Hospital Pharmacy
Day Surgery S 90 Community Pharmacy
Private Hospital Pharmacy Applications
Medical Centre Only - S90 PAN
(Pharmacy
Dental
Approval Number)
Allied Health
Community
Aged Care Veterinary
Other
(please specify)
Key Contacts - to help us make sure the right person gets information
Accounts / Statements Invoices (If different to accounts) Business & Marketing Updates
Name Name Name
Role Role Role
Email Email Email
Phone Phone Phone
CH2 Direct Ordering
(account setup) CH2 Link (access setup) Delivery Status Updates
Name Name Name
Email
Mobile
Landline
Role Role
Email Email
Phone Phone
Postal & Delivery Details
Postal Address
Town/Suburb
State Postcode
Contact Name Contact Role
Business Phone Fax
Tick if postal address is the same as delivery address
Delivery Address
Town/Suburb
State Postcode
Contact Name Contact Role
Business Phone Fax
Director/Partner/Sole Trader
Contact Name DOB
Personal Address
Town/Suburb State Postcode
Drivers License Email
Phone Mobile
Director/Partner/Company Secretary
Contact Name DOB
Personal Address
Town/Suburb State Postcode
Drivers License Email
Phone Mobile
Customer Account Application
03 9554 0490 03 9554 0400 chaccounts@ch2.net.au
2
0192348_CH2_CORP_CUSTOMER_APPLICATION_06122019
CH2 will send relevant promotional offers, operational
communication and other information to nominated
contacts.
I do not want to receive promotional offers from CH2
20192348_CH2_CORP_CUSTOMER_APPLICATION_06122019
Application for access to schedule products
Practitioner Registration to obtain scheduled product.
To obtain scheduled products a current Drugs & Poisons Permit or Licence or AHPRA registration or Veterinary Certicate MUST accompany this
application for all delivery sites.
Do you wish to purchase scheduled drugs? Yes (please state which schedule) No
Do you wish to purchase alcohol based products? Yes No
If YES, please provide details of valid and current permit/licence/registration/certicate.
Name on paperwork Signature
Type Number: Expiry date
CH2’s Terms and Conditions of Sale
By signing this Application, the Customer.
a. requests CH2 to enter into the trading account selected in the Trading Terms section of this application (Trade Credit Facility); and
b. acknowledges that by initiating the use of the Trade Credit Facility that they have been given the opportunity to read CH2’s Terms and Conditions of
Sale available at www.ch2.net.au/contact/terms-conditions (Terms and Conditions of Sale);
c. acknowledges that CH2 recommends that the Customer read the Terms and Conditions of Sale and discuss any terms that they do not understand
with a CH2 representative or an independent advisor before signing;
d. agrees and accepts that each order forms a separate contract that will be governed by the Terms and Conditions of sale; and
e. acknowledges that CH2 may vary its Terms and Conditions of Sale from time to time; and
f. accepts and agrees to be bound by the obligations of the Customer under the Terms and Conditions of Sale that are applicable on the date of a
relevant order being placed by the Customer with CH2.
Customer Declaration and Agreement to CH2’s Terms and Conditions
The Customer agrees that:
CH2 may seek consumer credit information (Section 18K(1)(b) Privacy Act 1988):
• If CH2 considers it relevant to assessing the Customer’s application for commercial credit, the Customer agrees to CH2 obtaining from a credit
reporting agency a credit report containing personal credit information about me/us in relation to commercial credit provided by CH2.
CH2 may exchange information with other credit providers (Section 18N(1)(b), Privacy Act 1988):
• The Customer agrees to CH2 obtaining personal information about it from other credit providers, whose names the Customer may have
provided to CH2 or that may be named in a credit report, for the purpose of assessing this application.
CH2 may obtain a consumer credit report to collect overdue payments on commercial credit (Section 18K(1)(h), Privacy Act 1988):
• The Customer agrees that CH2 may obtain a consumer credit report about it from a credit reporting agency for the purpose of collecting overdue
payments relating to commercial credit owed by the Customer.
Partnership Sole Trader
Signature Signature
Full name
of partner
(Please print)
Full name
(Please print)
Driver’s
License
Signature
of witness
Name of
witness
Address
of witness
Driver’s
License
Signature
of witness
Name of
witness
Address
of witness
Date
Date
Director 1 Director 2/Company Secretary
(if applicable)
Authorised Company Representative
Signature Signature Signature
Full name
(Please print)
Full name
(Please print)
Full name
(Please print)
Drivers
License
Drivers
License
Role
Date
Date
Date
I am the sole director and company
secreatry of the Customer
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20192348_CH2_CORP_CUSTOMER_APPLICATION_06122019
Guarantor 1
Signed, Sealed and Delivered as a Deed by the Guarantor in the presence of:
Signature Signature of Witness
Name Name of Witness
Driver’s
License
Address
Date Date
(Block Letters) (Block Letters)
Guarantee
In consideration of CH2 agreeing to supply or continuing to supply goods and services on credit to the Customer named above, each guarantor named
below (Guarantor) unconditionally and irrevocably guarantees to CH2 the due and punctual payment of all debts and monetary liabilities, including
without limitation, any money which may become payable by the Customer to CH2 under any Trade Credit Facility granted by CH2 to the Customer (the
Guaranteed Money). If the Customer does not pay any of the Guaranteed Money on time, CH2 may make a written demand to each Guarantor, or any of
them, to immediately pay the Guaranteed Money (or any part of it).
As a separate obligation, each Guarantor agrees to indemnify CH2 against any claim, action, loss, damage, liability, cost, expense, outgoing or payment
suffered, paid or incurred by CH2 in relation to the non-payment or non-recovery of the Guaranteed Money, or as a result of any breach by the Customer
of CH2’s Terms and Conditions of Sale.
Each Guarantor hereby agrees with CH2 that the above guarantee and indemnity (the Guarantee) are absolute, unconditional and irrevocable and shall
be continuing obligations of each Guarantor, and each Guarantor’s obligations and liabilities are not affected or released by any circumstance, act or
ommission, including:
a. the failure of any other person named as a Guarantor to execute this Guarantee;
b. any variation of the Terms ad Conditions of Sale or any other terms upon which the goods and/ or services are supplied to, or paid for by, the
Customer;
c. an increase in the amount of Guaranteed Money;
d. the fact that any credit was provided by CH2 or any related body corporate before this Guarantee was signed;
e. the death, liquidation or bankruptcy of the Customer or the Guarantor;
f. changes in the membership, name or business of a rm, partnership, committee or association, or the Customer; and
g. the granting of any time, waiver, credit, indulgence and/or concession to the Customer.
If another Guarantor signs this Credit Application, each Guarantor’s obligations are joint and several and each Guarantor’s obligations shall continue until
all amounts payable by the Customer have been paid.
Attention: Intending Guarantors warning please read
By signing this Customer Account Application the Guarantor:
a. agrees to be bound by the Guarantee above, all other provisions of this Customer Account Application and CH2’s Terms and Conditions of Sale ( as
applicable and relevant to that Guarantee);
b. acknowledges that the Guarantor has been given an opportunity to read CH2’s Terms and Conditions and that CH2 encourages the Guarantor to
do so;
c. understands that the Guarantor can refuse to sign this document;
d. understands that there are nancial risks involved in signing this document (for example, it may become necessary for the Guarantor to sell its assets
so that the guarantor can pay CH2);
e. declares that it has obtained legal and nancial advice as necessary or if it has not obtained such advice, declares that does not regard any such
advice as necessary and prefers to proceed without it; and
f. declares that it is fully aware of the nature of and risks in signing this Customer Account. Application and is signing it voluntarily.
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FOR OFFICE USE ONLY
Branch Shipping Warehouse BDM Customer type
AR Group Code Pricing - General/Medical Pricing - Vet Web Customer Type
Pricing - Pharma Pricing - Contract - 13 Pricing - Contract - 14
Backorders (Y/N) CH2 Direct - CH2 link (Y/N) Freight (Y/N) Cold Chain (Y/N)
Guarantor 2
Signed, Sealed and Delivered as a Deed by the Guarantor in the presence of:
Signature Signature of Witness
Name Name of Witness
Driver’s
License
Address
Date Date
(Block Letters) (Block Letters)
Guarantor 3
Signed, Sealed and Delivered as a Deed by the Guarantor in the presence of:
Signature Signature of Witness
Name Name of Witness
Driver’s
License
Address
Date Date
(Block Letters) (Block Letters)
20192348_CH2_CORP_CUSTOMER_APPLICATION_06122019
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Customer Account Application (Australian Broadcasting Corporation)

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Completed 27 June 2021

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