Wholesale Application Form

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Thank you for your interest in King Valley Fine Foods.

To enable us to provide you with the best possible service, we request you complete the following form. You may be assured the information you provide will be treated as confidential. We look forward to providing you with excellent service.

First Name(*)

Please type your first name.

Last Name(*)

Please type your last name.

Company Name(*)

Please type your full Company name.

Trading Name (if different)

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Country(*)

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Business Type(*)

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Date Business Commenced(*)

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ABN / ACN(*)

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Email Address(*)

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Phone Number(*)

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Fax Number

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Website URL

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Postal Address line 1

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Postal Address line 2

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Suburb

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State(*)

Please select your state

Postcode

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How Did You Hear About Us?(*)

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What is your preferred method of contact?

E-mailPhone

Please provide three trade references:

Trade Reference 1

Business Name(*)

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Business Address(*)

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Phone Number(*)

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Email(*)

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Trade Reference 2

Business Name(*)

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Business Address(*)

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Phone Number(*)

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Email(*)

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Trade Reference 3

Business Name(*)

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Business Address(*)

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Phone Number(*)

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Email(*)

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I/We hereby:(*)

Agree the information provided is true and correct.If granted credit, agree to settle within the terms offered which are 7 days from statement date.Acknowledge that credit may be withdrawn with out prior notice if compliance with these conditions is not adhered to.Agree that any change in respect of ownership, legal entity or address is to be notified immediately.Understand that failure to pay for any product purchased from King Valley Fine Foods will entitle King Valley Fine Foods to retake possession of their products.Certify that I am authorised to sign this credit application form on behalf of the Business. Invalid Input

Prove that you're human

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Thank you for your interest in King Valley Fine Foods. We will be in touch as soon as possible.