Flowers Express

Application For Corporate Account

*Denotes required fields


BUSINESS DETAILS

 

1.*Business Name

2.* Address

 

3.*Telephone
4.*Facsimile  
5.*Email Address  
6.*ABN and/or ACN


 


ACCOUNT DETAILS

 

7.*Account Contact Name   
8.*Position Title  
9.*Telephone  
10.*Facsimile  
11. Mobile Phone  
12.*Email Address  
13.Full name of persons authorised to use this account


14.*Trade References (2 minimum)


(please include Business names, contact names and contact numbers)

 

15.*Preferred Credit Limit

 $250 - $500
 $501 - $1000
 $1001 - $5000
 Over $5000

 

16.*Preferred Method Of Payment

 EFT (Electronic Funds Transfer)
 Credit Card
 Cheque


APPLICANT DETAILS

 

17.Your Name (if different from above)  
18.Your Email Address (if different from above)  
19.Preferred Account User Name  
20.Preferred Account Password  
21.*Declaration: Are you authorised by the company (stated in question one) to apply for a corporate account with Flowers Express ?
 Yes
 No
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