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Step 1 of 7
14%
Supplier
Supplier Invoice Number
CUSTOMER DETAILS
Date
Entity type
Company
Partnership
Trust
Sole trader
Other
Type Your Entity Type
Customer
If trust, name of trust
Trading name
Postal address
Contact name
Email
Phone
Mobile
Fax
ACN/ABN
(LOOK UP ACN/ABN)
Trust ABN
DIRECTOR DETAILS
Full name
Address
Driver licence no
GOODS
Description
Serial number (If Known)
Goods location address
Add Another Product
Yes
No
Description
Serial number (If Known)
Goods location address
Add Another Product
Yes
No
Description
Serial number (If Known)
Goods location address
Add Another Product
Yes
No
Description
Serial number (If Known)
Goods location address
TERMS OF PAYMENT
Number Of payments
12 Months
24 Months
36 Months
48 Months
Base Rentals $
GST
Gross Rentals $
INSURANCE
Business Content Insurer
Insurer Policy Renewal Date
CUSTOMER SIGNING
I acknowledge and declare that: 1. execution of this Tax Invoice by Fuji Xerox Asia Pacific Pte Ltd, Sydney Branch (Fuji Xerox) is subject to its normal credit criteria and approval; 2. before signing this Tax Invoice, I received and read a copy of the Terms and Conditions; 3. the credit (or goods) to be provided to me by Fuji Xerox is to be applied (or used) wholly or predominantly for business or investment purposes (or both).
Important: You should not sign this declaration unless this loan is (or the goods hired are) wholly or predominantly for business or investment purposes.
By signing this declaration you may lose your protection under the National Credit Code;
4. all of the information provided in and in connection with this Rental Agreement is true and accurate and discloses my correct financial position and will be relied upon by Fuji Xerox to determine whether or not to accept my application for finance; and 5. I have received, read and signed a copy of the Privacy Act Consent and Acknowledgement (only applicable if the Customer is a natural person). If the Customer is a company, then signed by its authorised officer or in accordance with section 127 of the Corporations Act 2001 (Cth).
Name
First
Last
Date
Signature