My Toners Application Form

Customer Application Form

Customer information

Registered business name*

Trading as

Business address*

Suburb / city*

State*

Post code*

Phone*

Fax

E-mail*

Mobile

Postal address(if not as above)

Post code

ABN*

ACN

Type of business*

Date of incorporation*

State*

Names, date of birth and residential address of directors/partners

Name*

DOB*

Address*

Name

DOB

Address

Name

DOB

Address

Printer Details

Printer Model *		Printer Description
Printer Model		Printer Description
Printer Model		Printer Description
Printer Model		Printer Description
Printer Model		Printer Description

Anticipated possible monthly purchases $

Disclosure

I/We the undersigned declare that the above application is true and correct and agree to the Terms and Conditions. I/We accept the Trading Terms its being CREDIT CARD unless otherwise agreed with an Authorized Officer of MyToners Pty Ltd. I/We are personally guarantee to pay in full for any goods which have been received by the above mentioned and are held personally liable for any outstanding debts at any stage.

Signature

Name:		Position:
Signature:		Date:

Witnessed:		On This Day:
Name:		Position:

PLEASE NOTE this application can only be signed personally by the Proprietor, by at least two partners or by the Director or the Secretary of the Company.

When you have completed the form press the "Continue & Print This Form" button to view and print your Application. Once printed, please sign the form and FAX it to MyToners on 1300 760 546. An account manager will create an account for you and contact you ASAP.