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COMPANY / BUSINESS

APPLICATION FOR COMMERCIAL ACCOUNT

CEVA PALLECON

Company Name:

ABN:

Trading Name:

Phone:

Business Address:

Incorporation Date:

Paid Capital:

Business Nature:

Credit Required:

FINANCIAL INFO (for applications over $20,000.00)

Current Asset:

Total Asset:

Intangible Asset:

Profit/Loss after tax:

Current Liabilities:

Non Current Liabilities:

Shareholder Equity:

DIRECTORS - Name and Private Addresses please:

Trade References:

Phone:

Fax:

We, (the Applicant) supply the information contained in this form for the sole purpose of obtaining a 14 day commercial credit account. We authorises ceva to make enquiries as to our credit worthiness in support of this application and subsequently in support of future trading. If the account is granted, We undertake to pay all amounts invoiced to us within the stated period. If any amount invoiced is not paid within the stated period, then all amounts invoiced to us by the company shall become due and payable immediately. We understand and acknowledge that ceva reserves the right to withdraw credit at any time at its absolute discretion.

Authorised by:

Email:

Position:

Phone:

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* All fields are mandatory - if not applicable - type 'N/A'

I Accept