Privacy:We understand that any personal information supplied to Lloyd Philips Group is confidential and will only be used for the purpose for which it is intended. Lloyd Philips Group will not disclose any information without your express permission or when required to do so by law. We hereby authorise Lloyd Philips Group to obtain the relevant information they require to grant credit from the trade references listed and/or from the Credit Bureau of their choice. We also authorise Lloyd Philips Group to provide information to a credit reporting agency to obtain a commercial and/or consumer report about us and allow the credit reporting agency create or maintain a credit information file containing information about us.
Company Name
Trading Name
Address
Suburb Post Code
Mailing Address
Phone Number
Fax Number
Email
Contact Person
Title
Mobile
Accounts Contact
Office Use Only Axiom Code Date Entered Companies Principle Activites: Number of Full Time Staff Number of Casual and Agency Staff Work Place Number Industry WorkCover Classification Code Occupational Health and Safety
Axiom Code
Date Entered
Companies Principle Activites:
Number of Full Time Staff
Number of Casual and Agency Staff
Work Place Number
Industry WorkCover Classification Code
Occupational Health and Safety
Do you have a system for managing safety? Yes No
Is the system for managing safety a documented system? Yes No
Do you have an OH&S Policy Statement? If yes please attach? Yes No
Do you have a site specific Induction Process for Agency Staff? Yes No
Do you have a formal incident reporting procedure/process? Yes No
Do you have a system for managing bullying/harrassment and drug issues? Yes No
Additional Comments regarding OH&S:
Company 1
Trading Period
From
To
Annual Spend (Approx)
Company 2
Company 3
Thank you for completing our Account Customer Application Form. We will process your application and contact you within the next 24 to 48 hours. We may require Director's Guarantees to be signed. Please download a copy here.
Our On Hire Agreement can be downloaded here. Please sign the On Hire Agreement and return via facsimile on 1300 852 744.
LLoyd Philips