| Billing Details |
| Billing Address (Postal) |
Same as address details |
| Suburb | |
| Post Code | |
| State |
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| Main Telephone Number (Switch) | (Including area code) |
| Fax Number | (Including area code) |
| Consent |
| a) Credit Reporting Agency Check |
If Prodocom considers it relevant to assess my/our application for commercial credit, I/We agree to Prodocom obtaining from a credit reporting agency a credit report containing personal credit information about me/us in relation to commercial credit provided by Prodocom.
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| b) Trade References |
Please supply 3 long term suppliers not associated to your company
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| 1) Supplier Phone Number (Including area code) |
| 2) Supplier Phone Number (Including area code) |
3) Supplier Phone Number (Including area code)
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| c) Credit Limit (Monthly) |
The monthly credit limit I require is $
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| d) Declaration |
I/We confirm that the information supplied is correct and I/we agree to be bound by Prodocom standard terms and conditions. By submitting this application, we agree that we will not use the Service to be provided by Prodocom to transmit or publish any material which is defamatory of any person, or material in breach of copyright or any obligation of confidentiality, or otherwise in breach of any law, and we will indemnify Prodocom for any loss or expense it suffers as a consequence of our doing so.
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| Services |
| Please also indicate which Prodocom services you need further information on, once this application is complete |
|
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To complete the registration we need to allocate to you a master login to the website.
This will only become active once we have approved your request. Please complete the following information |
| Firstname | |
| Lastname | |
| Position | |
| Department | |
| Email Address | |
