1. Business Details

Choose Business Details * Sole TraderPartnershipCompanyTrading TrustGovernment Authority
Company or Business Name
Trading Name
ABN
ACN

Business Addres

Business Postal Addres

2. Type of Business

Nature of Business
Industry Type
Number of Employees
Premises
Holding Company

Holding Company Name

Holding Company ACN

3. Trade/Business References (Three Major Suppliers) Business One

Business Name
Job Title
Contact Name
Phone Number

Business Two

Business Name
Job Title
Contact Name
Phone Number

Business Three

Business Name
Job Title
Contact Name
Phone Number

4. Details of Sole Trader/Partners/Directors or Trustees

Director/Trustee Name
OwnedRentedMortgaged
Phone Number
Date of Birth
Drivers License Number
State
Maiden & Other Names (if any)

All account information is secured with our SSL Certification Protocol. Your details will not be shared.

5. Credit limit Request

Please enter a dollar figure* *

Please note: If credit limit exceeds $5,000 we will also require financials. Please see Section 6 below.

6. Assets and Liabilities of Business

Attach copy of. your latest Financial Statements including Csh Flow/Profit and Loss and Balance Sheet

7. Signatures and Authorisations

Upload File

I Agree with the Terms & Conditions Below:
On behalf of the Business nominated in this Application, as the purchaser of Services provided by Gateway Express Truck Wash. I/We being the duly authorised officer(s) have read and agree to accept the terms and conditions for the operation, establishment and use of an account and hereby apply for the establishment of such Credit Account. I/We warrant that the information provided by me/us in this Application is true and complete.
Authorised Signatory's Name and Title* *
Privacy Notice
We collect your personal information so we can assess your application for a Gateway Express Truck Wash Credit Account We will be unable to assess your application or provide you with access to a Business Credit Account without all or part of the personal and other information we require In order to assess your application for credit you hereby consent to your personal information being disclosed to third parties. This may include disclosure on the Personal Property Security Register, to reporting agencies (eg Veda Advantage), companies who provide commercial credit references (eg Dunn and Bradstreet), people you authorise us to contact in connection with this application or any approved Business Credit Account, Mercantile Agencies and other Companies, who provide outsourced services to us Subject to certain exceptions allowed by law you may request access to your personal information while it is stored by us. We will give you reasons where we deny you access With your implied consent we may use your personal information to tell you about other Gateway Express Truck Wash services and offers we may think will be of benefit to you.

Brisbane Express Truck Wash at Nudgee is 20 times faster and a fully automatic wash, from a 2 tonne van through to B-Double configurations, cranes and other machinery in 8 to 12 minutess. No booking and No Queues as we can wash fully loaded carriers with driver inside the vehicle. Our wash will cater for most vehicles and has inter clean technology. Fleet accounts are available. Gateway Express Truck Wash is located behind Shell at Nudgee Service Centre off Exit 112 on the Gateway Motorway.

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