Trade Application Form

Company Billing Details

The following information supports your application with Halogen DJ Company (hereby referred to as the "Firm” in this document). Halogen DJ Company is happy to offer our valued customers the opportunity to take advantage of our trade discounts for any person or business enterprise when the following information has been verified by referees and credit reporting agencies.

Company *

Address *

Suburb *

State *

Postcode *

Country *

Tel No. *

Alt No. *

Email *

Confirm Email *

Date Company Registered *

Date Business Registered

I.e. business name, T/As, etc.

Expected Monthly Spend *

Credit Limit Requested *

Nature of Business *

Type of Entity *

E.g. Sole Trader, Partnership, etc.

Delivery Address

Number *

E.g. Unit No., Apartment No., Floor No., Building No., etc.

Address *

Suburb *

State *

Postcode *

Country *

Personal Details

First Name *

E.g. Proprietor / Guarantor / Nominee

Middle Name

Last Name *

Position Held *

Your position within the company.

Address *

Suburb *

State *

Postcode *

Country *

Date of Birth *

Tel No. *

Alt No. *

Email *

Confirm Email *

How Did You Find Us? *

ie. Google, Referral, etc.

What Did You Type In? *

ie. DJ hire, Speaker hire, etc.

Identification Details

(You submit the following uploaded documents as evidence of your identity) All images must be clearly visible, and driver's licenses and other cards must have back and front uploaded. All IDs must be current and within their expiry date. We do not accept international ID. This is to verify your identity so that no one can book on your behalf, to confirm that the identification details provided are not from a fraudulent card, and can be used for other applications as outlined in the Terms and Conditions. All ID provided must belong to the Proprietor/Guarantor/Nominee.

ABN *

ACN

ABN Registration Certificate *

Click or drag a file to this area to upload.

ASIC Registration Certificate *

Click or drag a file to this area to upload.

Driver's Licence Or Proof Of Age Card - Front *

Click or drag a file to this area to upload.

Driver's Licence Or Proof Of Age Card - Back *

Click or drag a file to this area to upload.

Payslip - Must Be From The Last 2 Months *

Click or drag a file to this area to upload.

Wage amount does not need to be provided.

Utility Bill From The Last 3 Months *

Click or drag a file to this area to upload.

E.g. gas, electricity, water, phone and internet.

Credit Card Details

(You submit the following uploaded documents) All images must be clearly visible, credit card must have the back and front uploaded. The credit card must be current and within its' expiry date and must belong to the Proprietor/Guarantor/Nominee, to ensure that the details provided are not from a fraudulent card, and can be used for other applications as outlined in the Terms and Conditions.

Institute *

e.g. banks, credit unions

Branch *

e.g. location of branch

Card Holder *

Card Type *

Card No. *

Expiry *

CVV No. *

Located at rear of card

Credit Card - Front *

Click or drag a file to this area to upload.

Credit Card - Back *

Click or drag a file to this area to upload.

Bank Details

These details are collected for the return of payments, and can be used for other applications as outlined in the Terms and Conditions.

Institute *

e.g. banks, credit unions

Account Name *

BSB No. *

Account No. *

Trade References

These must be Suppliers which you conduct business with on a weekly or monthly basis.

Trade Reference - 1

Trading Name *

Contact Name *

Title Held *

The contact's position within the business.

Address *

Suburb *

State *

Postcode *

Country *

Tel No. *

Alt No. *

Email *

Confirm Email *

Nature of Business *

Date Commenced *

The date that you began conducting business with the Supplier.

Average Monthly Spend *

Have you ever been late on a payment?

If yes, please provide futher details below.

Trade Reference - 2

Trading Name *

Contact Name *

Title Held *

The contact's position within the business.

Address *

Suburb *

State *

Postcode *

Country *

Tel No. *

Alt No. *

Email *

Confirm Email *

Nature of Business *

Date Commenced *

The date that you began conducting business with the Supplier.

Average Monthly Spend *

Have you ever been late on a payment?

If yes, please provide futher details below.

Trade Reference - 3

Trading Name *

Contact Name *

Title Held *

The contact's position within the business.

Address *

Suburb *

State *

Postcode *

Country *

Tel No. *

Alt No. *

Email *

Confirm Email *

Nature of Business *

Date Commenced *

The date that you began conducting business with the Supplier.

Average Monthly Spend *

Have you ever been late on a payment?

If yes, please provide futher details below.

Instructions

Please ensure to provide any other additional infomation that we may need.

Have you ever declared bankruptcy? *

Or any other associated business.

Have you ever been liquidated? *

Or any other associated business.

Have you ever been repossessed? *

Or any other associated business.

I agree that all the above details are true and correct.

I authorize Halogen DJ Company to contact the above names to assist in assessing the application.

I accept full responsibility for the safe return of equipment, and agree to indemnify Halogen DJ Company for all loss or damage to equipment supplied to the enterprise.

I understand that I will be guaranteeing the performance of the corporate entity, and accept responsibility for any debts incurred by the enterprise.

I agree to the Terms and Conditions.

Please read our terms and conditions.

I understand that I am making a booking and entering into a written contract with Halogen DJ Company.

Trade Application Form

Company Billing Details

Delivery Address

Personal Details

Identification Details

Credit Card Details

Bank Details

Trade References

Trade Reference - 1

Trade Reference - 2

Trade Reference - 3

Instructions

PLEASE ALLOW UP TO 3 MINUTES FOR THIS FORM TO SUBMIT