Lowes Petroleum Service Account Application Form

Please complete and submit the form, and our sales team will be in contact with you.

Step 1 of 6 - Introduction

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Before you begin, have the following information at hand:
- Your ABN
- Your Driver's Licence Number
- If you are a company, the Date of Birth, Driver's Licence Number, Address
  and Phone Number of all Directors and Guarantors
- Contact details for three Trade References
- If you are a Company, Guarantors' approval of the Lowes Terms and Conditions.

YOUR DETAILS
YOU MUST COMPLETE ALL DETAILS IN ONE OF THE THREE SUB-SECTIONS ON THIS PAGE, DEPENDING ON WHETHER YOU ARE A SOLE TRADER, A PARTNERSHIP OR A COMPANY.
Are you a:*
- Sole Trader?
- Partnership?
- Company?
Sole Trader Details
Your Name*
FirstLast
Date Of Birth*
Driver's License Number*
ABN*
Address*
Street AddressCityZip / Postal Code
Phone - Work*
Phone - Home
Phone - Mobile
Fax*
Email*
Partnership Details
Name of Partnership*
ABN*
Address of Partnership*
Street AddressCityZip / Postal Code
Phone - Work*
Phone - Home
Phone - Mobile
Fax*
Partner 1
Name of Partner*
Date of Birth*
Driver's License No.*
Address*
Street AddressCityZip / Postal Code
Phone*
Partner 2
Name of Partner*
Date of Birth*
Driver's License No.*
Address*
Street AddressCityZip / Postal Code
Phone*
Partner 3 (if applicable)
Name of Partner
Date of Birth
Driver's License No.
Address
Street AddressCityZip / Postal Code
Phone
Company Details
Company Name*
ABN*
Company Phone*
Company Fax*
Company Address*
Street AddressCityZip / Postal Code
Director 1
Name of Director*
Date of Birth*
Driver's License No.*
Address*
Street AddressCityZip / Postal Code
Phone*
Director 2 (if applicable)
Name of Director
Date of Birth
Driver's License No.
Address
Street AddressCityZip / Postal Code
Phone
Director 3 (if applicable)
Name of Director
Date of Birth
Driver's License No.
Address
Street AddressCityZip / Postal Code
Address and Phone No.
Please provide the details of at least one Guarantor failing which Lowes Petroleum Service may only supply goods on a “Cash on Demand” basis.
Guarantor 1
Name of Guarantor*
Date of Birth*
Driver's License No.
Address
Street AddressCityZip / Postal Code
Phone*
Guarantor 2
Name of Guarantor
Date of Birth
Driver's License No.
Address
Street AddressCityZip / Postal Code
Phone
Guarantor 3
Name of Guarantor
Date of Birth
Driver's License No.
Address
Street AddressCityZip / Postal Code
Phone
As a company, including Guarantors on your application is the standard requirement of Lowes Petroleum Service. If you, the applicant, feel that you cannot complete the guarantor section, we ask you to continue filling out the application to the end and a representative will be in contact within 2 working days to go through your application with you.

TRADE REFERENCES
Please provide the details of at least three trade references (major suppliers):
Trade Reference 1
Name of Trade Reference*
Addresss*
Phone*
Contact Person*
Trade Reference 2
Name of Trade Reference*
Address*
Phone*
Contact Person*
Trade Reference 3
Name of Trade Reference*
Address*
Phone*
Contact Person*

DETAILS OF YOUR BUSINESS
Where is your principal place of business?*
What is the nature of your business?*
When was the business established?*
What is the annual turnover of your business?*
What are your anticipated average monthly purchases?*

BUSINESS PURPOSE DECLARATION
I/We declare that the credit we are applying from Chippen Holdings Pty Ltd is to be applied wholly or predominately for:*
- 1. Business Purposes, or
- 2. Investment purposes other than investment in residential property.
What percentage of the goods use will be for business?*
IMPORTANT: You should only complete this declaration if this loan is wholly or
predominately for:
1. Business Purposes, or
2. Investment purposes other than investments in residential property.

By completing this declaration you may lose your protection under the National Credit Code.

If your response indicates that the goods are not to be used predominately or wholly for business purposes then the proposed agreement may fall under the National Credit Code.

Lowes Petroleum does not accept applicants that fall under the National Credit Code.

TERMS AND CONDITONS
By clicking “Submit Application” below, your application will be sent to Lowes Petroleum for consideration, and you are acknowledging and agreeing that the customer, its agent or servant, and all guarantors have read and understands the terms and conditions. Print Terms and Conditions.
By clicking “Submit Application” below, your application will be sent to Lowes Petroleum for consideration, and you are acknowledging and agreeing that the customer and its agent have read and understands the terms and conditions. Print Terms and Conditions.
Client Agreement*
- I have read and agree to the Terms and Conditions.

Lowes Petroleum Service Account Application Form

Step 1 of 6 - Introduction

YOUR DETAILS

Sole Trader Details

Partnership Details

Partner 1

Partner 2

Partner 3 (if applicable)

Company Details

Director 1

Director 2 (if applicable)

Director 3 (if applicable)

Guarantor 1

Guarantor 2

Guarantor 3

TRADE REFERENCES

Trade Reference 1

Trade Reference 2

Trade Reference 3

DETAILS OF YOUR BUSINESS

BUSINESS PURPOSE DECLARATION

TERMS AND CONDITONS

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