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Please complete, print, sign and fax back to your local DGI Office
NEW ACCOUNT REQUEST

COMPANY NAME:
BILLING ADDRESS:
POST CODE
A.B.N/ BUSINESS REGISTATION NUMBER/V.A.T
PHONE
FAX
DELIVERY ADDRESS (If different from billing address)
ADDRESS:
POST CODE
CONTACTS
ACCOUNTS:
POSITION:
E-MAIL:
PHONE:
OPERATIONS:
POSITION:
E-MAIL:
PHONE:
TWO TRADE REFERENCES
  
COMPANY:
CONTACT NAME:
ADDRESS:
POST CODE:
PHONE:
FAX:
COMPANY:
CONTACT NAME:
ADDRESS:
POST CODE:
PHONE:
FAX:
AUTHORISATION:
The account holder undertakes that the information given in connection with this application is true and complete. The account holder consents to DGI making such enquires as is shall deem necessary regarding this application, and accepts that DGI reserves the right in its absolute discretion to reject this application without being required to state any reasons. If the application is accepted, the account holder agrees to be bound by the Terms & Conditions.
OUR PAYMENT TERMS ARE 14 DAYS FROM THE DATE OF INVOICE.
SIGNED BY: (SIGNATURE OF AUTHORISED PERSONNEL)
NAME: POSITION:
 


 

 

 


 

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