BUSINESS DETAILS
Trading As:
Company
Name of Entity:
Peter Gambera
ABN/ACN of company/business:
12345678901
Trading Name:
As Above
How Many Cards Applying For:
1
Fuel Spend Per Month:
$300
Postal Address:
8/134 Canterbury Road
Blackburn South, VIC
3130
AU
Work Number:
87512288
Fax Number:
0387512288
Contact Person:
Peter Gambera
Mobile Number:
413099834
Email Address:
cardexadmin@gmail.com
Title:
Director
TYPE OF BUSINESS
Nature of Business:
CrissCross It Pty Ltd
Industry Type:
a
Date Commenced:
10/10/2019
Number of Employees:
4
DETAILS OF SOLE TRADER / PARTNERS / DIRECTORS / TRUSTEES
1. Full name of Proprietor / Partner / Director / Signatory:
Peter Gambera
Title
Mr
Date of Birth
01/04/1952
Residential Address: Not P.O. Box
123 new st kew 3176
Drivers License No:
1234567a
State
VIC
2. Full name of Proprietor / Partner / Director / Signatory:
Title
Date of Birth
Residential Address: Not P.O. Box
Drivers License No
State
SIGNATURE & CONSENT
Signatory’s full name:
Peter Gambera
Title (Business Only):
Director
Signature
Date Signed
11/14/2021
Joint applicant full name (1)
Signature
Date Signed
Joint applicant full name (2)
Signature
Date Signed
Preferred Payment Cycle: *Direct Debit Only
Monthly