Credit Application

Clean Hands invites you to apply for a business level account. This provides you with the option of purchasing Clean Hands product through our website with 14 day payment terms. Once approved, simply choose 'Invoice' as your payment option on checkout.

Simply fill in the on-page form to apply for 14 days payment terms.

If you'd prefer, you may download the form/s listed below and read them in conjunction with our Terms of Service, fill them in and return to Clean Hands either via email; accounts@cleanhands.com.au or mail, Unit 7, 15/17 Chaplin Drive, Lane Cove West, 2066 NSW, or give us a call on (02) 8021 9865, to organise a time for us to come to you.

DOWNLOAD CREDIT APPLICATION

DOWNLOAD DIRECT DEBIT APPLICATION

Credit Application On-page Form
Organisation*
Business Type*
Other Business Type*
Trade Name*
Legal Name*
Delivery Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Postal Address*
Same as delivery address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Telephone*
Fax
Mobile*
Best delivery time(s)*
Your ABN*
Orders contact
Name of person in charge of ordering*
First Last
Mobile of above person*
Email of above person*
Accounts & Accountant's contact
Accounts contact*
First Last
Accounts email*
Trade References: (excluding Credit Cards, Fuel Suppliers, Landlord, Power & Phone)
1. Trade Reference Name*
1. Trade Reference Phone*
2. Trade Reference Name*
2. Trade Reference Phone*
3. Trade Reference Name
3. Trade Reference Phone
Certify Details
Certify*
- I certify that the above information is true and correct and that I am authorised to make this application for credit. In accordance with the Privacy Act (1988) I authorise any person or company to give information as may be required in response to credit Inquiries. I have read and understand the TERMS OF SERVICE (https://cleanhands.com.au/terms-of-service/) which form part of and are intended to be read in conjunction with this Credit Application and agree to be bound by these conditions. I understand that all products remain in possession of Clean Hands until full payment.*
Your name*
First Last
Your email*
Your position*
Guarantor's Details
Guarantor's name
First Last
Guarantor's email
Guarantor's phone
Consent*
- I consent to my data being collected and stored as per the terms of the Clean Hands privacy policy*
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Credit Application

Credit Application

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