30 Day Credit Account Application

BRIGHTLITE NOMINEES PTY. LTD. A.C.N. 005 137 217

Trading as Beacon Lighting

Please complete all sections of this form.

I/We hereby apply for a 30 day credit trading account and submit the following strictly confidential information for this purpose, to BEACON LIGHTING, Level 1, 295 Whitehorse Road, Nunawading VIC 3131.

General Information

Please complete all details

Company Name

ABN No

Trading Name

Address

Suburb

State

Postcode

Telephone Number

Mobile Number

Fax Number

Email Address for accounts payable

Company Details

Full names, addresses and telephone numbers of Proprietors / Directors. Please complete all details.

Director Name (Person one)

Address (Person one)

Telephone (Person one)

Director Name (Person two)

Address (Person two)

Telephone (Person two)

Director Name (Person three)

Address (Person three)

Telephone (Person three)

Nature of business

Number of years in operation

Approximate monthly turnover

Trade Credit Reference Details

Please provide contact details of three companies from which you currently receive credit:

Company Name (Company one)

Address (Company one)

Email Address and/or Telephone Number of Accounts Department (Company one)

Company Name (Company two)

Address (Company two)

Email Address and/or Telephone Number of Accounts Department (Company two)

Company Name (Company three)

Address (Company three)

Email Address and/or Telephone Number of Accounts Department (company three)

Expected Monthly Purchases from Beacon Lighting

Requested Credit Limit from Beacon Lighting

AUTHORITY (Privacy Act 1988) To: Beacon Lighting

I/We, the Applicant (s) named below hereby authorise Beacon Lighting as follows: 1: To give and receive from various financial authorities personal information about Me/Us in connection with our application for a trading account. 2: To advise me/us named below, that My/Our application has been approved or declined. 3: To advise me/us named below of the amount required to be paid to Beacon Lighting to discharge My/Our credit indebtedness to you from time to time. 4: To provide to me/us, named below, a copy of my/our credit report held by Beacon Lighting in relation to an application for an account provided to Me/Us by Beacon Lighting. 5: To provide access to consumer/commercial credit information held by you in relation to Me/Us. Beacon Lighting Privacy Statement Brightlite Nominees Pty Ltd, trading as Beacon Lighting, acknowledges and is committed to protecting your privacy. We will collect, use and disclose and hold personal information in accordance with the Privacy Act 1988. For further information on Beacon Lighting’s Privacy Policy visit our website at www.beaconlighting.com.au

AUTHORITY (Privacy Act 1988)

Tick to agree

Terms and Conditions of Sale

Do you accept the Terms & Conditions of Sale?

Yes, I accept the terms and conditions of sale.