Spike | Credit Application

Experient | Vendor Application
Application Date

DayMonthYear
Date
Please advise who at Experient requested this form to be completed
Business Details
Company Name*
Trading Name (if different)
Company ABN*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Type of work your company can provide*

Signage Manufacturing / FabricationSignwriting / InstallationLED / IlluminationLaser / Water Cut Acrylic / MetalTactile Print / Braille / EngravingLarge Format PrintProfessional Services (Engineering, Design, Consultation etc)Other
Year Business Was Established*
All installers / installation crews will be required to complete a safety induction and provide additional information upon approval.
Billing Requirements

Billing Details:

Please invoice using the following details

NSW

QLD

VIC

Experient Group Australia Pty Ltd
ABN: 79 391 267 337

5/1-3 Nicholas Street
Lidcombe NSW 2141

Experient Group Australia Pty Ltd
ABN: 79 391 267 337

1210/17 Gould Road
Herston QLD 4006

Experient Group Australia Pty Ltd
ABN: 79 391 267 337

1/3 Cubbit Way
Dandenong South VIC 3175

02 8876 7900

07 3074 9506

03 9118 2748

Claims:

All claims must be submitted by the 25th of each month to accounts@experient.com.au with a breakdown % of works claimed or clearly outlining the items being charged. Please do not send any invoices to any other contacts, these will not be processed.

Only works completed to date either on-site or provided to Experient will be processed within payment periods.

Please ensure that the provided Purchase Order # is quoted on invoices & all correspondence.

Variations:

All variations must be approved for in writing by the Project Manager and have a relevant updated Purchase Order or Change order
issued.

Payment Terms:

Payment Terms are strictly 30 EOM

Email for remittances*
example@example.com
Accounts Contact Details
Accounts Contact*

First NameLast Name
Direct Phone*

Area CodePhone Number
Direct Email*
example@example.com
Banking Details

Please upload copy of bank deposit slip or bank details on letterhead signed by director/finance manager
Bank Name:
Account Name:
BSB:
Account Number:
Copy of bank deposit slip or bank details on letterhead duly signed

Cancelof
Insurances

Please upload copies of valid insurance if you will be doing installation work
Public & Products Liability Insurance

Cancelof
Workers Compensation Insurance

if sole trader, please upload letter of non-required coverage signed
Cancelof
Execution
Full Name*

First NameLast Name
Email Address*
a copy of this application will be emailed to you
Date

DayMonthYear
Signature

Clear
internal email*
example@example.com
Approver Email*
example@example.com
Should be Empty:

Experient | Vendor Application

Business Details

Billing Requirements

Accounts Contact Details

Banking Details

Insurances

Execution