Application – KPTech

Credit Application

Please select the type of customer application you would like to complete.

Business CustomerCompany details, director/accounts information, one required trade reference and an optional second reference. Personal CustomerIndividual customer details with no business information or trade references.

KPTech

U2/247 Milne Rd
Modbury North SA 5092
P 1300 303 173
E accounts@kptech.com.au

ABN: 73 350 925 217 KPTech Trading & 7 Day Credit Application

Applicant Details

Company Name *

Trading Name

Years Trading

ABN

Billing Address

Street Address

Director Name *

Director Email *

Director Mobile *

Accounts Payable Name

Accounts Payable Email *

Company Telephone

Fax

Trade References

Please provide at least one trade reference for the credit terms approval. A second reference is optional.

Trade Reference 1 *

Company Name *

Address

Contact Name *

Phone Number *

Accounts Email

Trade Reference 2 (optional)

Company Name

Address

Contact Name

Phone Number

Accounts Email

Business credit terms are strictly 7 days from invoice date unless otherwise agreed by KPTech.

Services Interested In

Please tick any services you would like KPTech to contact you about.

Microsoft 365 Backup 3CX / Phone Web Internet Mobile Phone Security

Payment Method

Select the preferred payment method. Card details are completed through KPTech's secure payment facility; this WordPress form does not store full card numbers or CVV.

Preferred Payment Method

Cardholder / Account Holder Name

Card last 4 digits

Bank Institution

Bank Account Name

Bank BSB

Terms and Conditions

I am authorised to represent and bind the applicant with respect to this application.

I authorise KPTech to undertake any credit enquiries in support of this application and I authorise the Trade Referees to provide to KPTech the information requested to support this application.

In the event of default in the payment of any invoice rendered by KPTech for goods and services, I agree to pay admin fees of $16.50 for each failed direct debit attempt and $33 or 2% (whichever higher) of any outstanding amounts after 30 days, 60 days and 90 days overdue. After 90 days overdue, I agree to pay all costs incurred by KPTech in relation to debt collection fees and solicitor’s costs. Title of goods is not transferred to the customer until payment is received in full by KPTech. $22 or 20% (whichever higher) restocking fee applies to cancelled or returned goods after the product has been special ordered for you.

Where the applicant is a company, the person signing is personally liable to pay our invoices (and/or recovery costs referred to above) if the company fails to do so after 90 days of invoices falling due.

I have read and agree to the Terms and Conditions above. (Required)

Authorised Signatory

Name (please print) *

Position / Title *

Date *

Signature *