Credit form
All information must be filled to accept application
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First Name:
Surname:
Address:
State:
Email:
Suburb:
Post Code:
Phone No:
Lodge, Chapter, Preceptory Etc: Name: Number: State: (Where the regalia will be used)
Amount of Credit Required: $
Period of Credit Required:
Minimum of $50 per month
Signature of Applicant:
Date of Application:
Print Name:
Please ensure that you have read the requirements and conditions of credit. (See credit requirements and conditions page) and a signed copy is enclosed with this application of credit.
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Office Use Only
Amount Admin Fee cost 10%:
$
Period of Credit Approved:
No of Months
Amount of Credit Approved: $
Number of Months :
Amount per Month:
Total Credit Approved: $
Start Date:
Finish Date: