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Credit Application Form

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Your Details
  1. Please enter a valid email address e.g. ryan@example.com Thank you for entering a valid email

Company Details
  1. No spaces or brackets e.g. 0390001234 That's what we wanted!

  2. No spaces or brackets e.g. 0390001234 That's what we wanted!

  3. No spaces or brackets e.g. 0390001234 That's what we wanted!

Reference Details
Optional Any Registration Certificate, Please Upload

SECURITY
Accept Terms & Conditions

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Accept Terms & Conditions

I/We authorize “Diagnostic & Medical Pty Ltd” to obtain from any person/company any Information we require for credit application purposes.

I/We authorize “Diagnostic & Medical” to provide any third party in response to credit reference Inquiries about me/us or by way of information exchange with credit reference agencies, details of this application and any subsequent dealings.

I/we certify that the information supplied in this application is true and correct.
I/we undertake to effect settlement at the office of Diagnostic & Medical Pty Ltd within the agreed terms.

I/we understand that Diagnostic & Medical Pty Ltd may, at any time and without assigning any reason thereto, cancel or suspend any credit facility provided and I/we agree that Diagnostic & Medical Pty Ltd will not be held responsible for any loss or damage caused by such cancellation or suspension and I/we further agree to indemnify the aid Diagnostic & Medical Pty Ltd for any claim which may arise from such cancellation or suspension. I/we have the authority to make this application.