Business Details Form

Please complete the form below (Fields marked * are required)
or Download the form as a PDF (requires Acrobat Reader) and email to us.

*Company/Trading Name:
*Business Address:
Postal Address:
As Above
Web Site:
*Full Name of Proprietor(s):

*Address of Proprietors:

*Name of Bank:

*Bank Branch:

*Account Name:
*Preference For Payment:
Cheque, Credit Card, Eft/Direct Deposit
*Please furnish the name and telephone number of two business references:
Reference 1:

Reference 2:
*I/We wish to make an application to open a credit account with
Cotton On Creations in accordance with the following conditions:
  • Terms are strictly nett 30 days from the date of invoice
  • Any accounts which remain unpaid after 45 days shall thereafter
    be shipped on a C.O.D basis only.
  • Credits will only be given if this office is notified of
    the reason within 10 days of delivery.
  • I/We agree that any costs incurred in the collection of overdue
    accounts shall be met by me/us.