Fresh Food Solutions in WA | Country Pak

Customer Hub

At Country Pak, we pride ourselves on treating our customers like extended family. This ethos underpins many long-term relationships that we have with our customers.
If you are thinking about using Country Pak as your fruit and vegetable supplier, you will be pleasantly surprised by the effort our team makes to support you, both in the initial setup or changeover, as well as the longer-term commitment to deliver for your business.

Credit Application

1Step1

2Step2

3Step3

Confidential

Type of Business

Sole Trader

Partnership

Private Company

Other please specify

Anticipated weekly purchase $

Trading Name

Date Commenced

Company Name

ABN

Postal Address

Phone

Fax

Mobile

Email Address

Delivery Address

If Company, Reg Office Address

Full Names and Residential Address of Sole Traders / Partners / Directors:

Bank

Branch

Name on cheque

Business Reference

Address

Fax Number

Have you ever been declared bankrupt or been a Director of any Company, which has been wound up or liquidated (whether voluntary or otherwise)

Yes

No

If Yes, please give details

Purchasing Manager

Accounts Representative

Director

Signature

Date

Confidential

Full Company Name

ABN

Company Address

Directors Name in FULL

Residential Address

Home Phone No

Director's Signature

Witnessed By

Witness Address

Directors Name in FULL

Residential Address

Home Phone No

Director's Signature

Witnessed By

Witness Address

Sole Trader Guarantee

Full Company Name

ABN

Company Address

Directors Name in FULL

Residential Address

Home Phone No

Director's Signature

Witnessed By

Witness Address

Directors Name in FULL

Residential Address

Home Phone No

Director's Signature

Witnessed By

Witness Address

Customer Hub

Credit Application

Preferred Suppliers