Fuji Xerox Supplies ? Online Credit Application form

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Apply for a Credit Account

A credit account gives a customer of Fuji Xerox Australia Ltd a Credit Account Facility subject to the Terms and Conditions of this Account Application:

I/We would like to request to open an Account Facility with Fuji Xerox (* Mandatory fields)

Application Details

Company *
T/As *
ABN *
Contact Name *
Street Address *
Suburb *
Postcode *
State *
Email Address *
Telephone Number * (max. of 10 digits w/o space)
Type of Business *
Facsimile Number * (max. of 10 digits w/o space)

Statement/Invoice Details

Same as Contact Name
Contact Name*
Same as Company Street Address
P.O. Box / Street Address *
Suburb *
Postcode *
State *
Would you like to receive statements online ? *
Yes No

Nature of Entity

Pty Ltd Sole Proprietor Partnership Trust

Trade References

Name *
Street Address *
Telephone Number * (max. of 10 digits w/o space)
Facsimile Number * (max. of 10 digits w/o space)
Email Address
Name *
Street Address *
Telephone Number * (max. of 10 digits w/o space)
Facsimile Number * (max. of 10 digits w/o space)
Email Address
Name
Street Address
Telephone Number (max. of 10 digits w/o space)
Facsimile Number (max. of 10 digits w/o space)
Email Address

Terms & Conditions

By ticking on this box, I/We acknowledge and agree to the terms and conditions of this credit account application.