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Commercial Application Form

Want to make Supagas your gas supplier? Simply complete an online application and one of our representatives will contact you shortly to arrange any gas requirements you may have. Alternatively you can visit your nearest branch or contact us on 13 78 72 to speak to one of our gas experts.

All Supagas customers are required to complete the new account application form.

Download Application Form (PDF) or apply online

 

* Required fields

Type of Business: Private Company Public Company Sole Trader* Patnership*
(*copy of drivers licence required)
Drivers licence no.
(if required):
ABN / ACN:*
Company Name:
Trading Name / Business Name:*
Compliance Plate No (if applicable):
Delivery Address:*
Suburb:*
Postcode:*
State:
Postal Address:
Suburb:
Postcode:
State:
Phone Number:*
Mobile Number:
Fax Number:
E-mail Address:*
Registered Office:
Director / Partner's Name:
Director / Partner's Home Address:
Suburb:
Postcode:
State:
Trade References:
  Company Contact Avg Mthly Purchases Contact No. Trade Yrs
1*
 
2
 
3
 
Business Premises: Rented Owned
If rented, Landlord's name:
Phone Number:
Monthly Credit Required: $
Purchasing Contact Person:
Purchasing Contact Phone Number:
Accounts Contact Person:
Accounts Contact Phone Number:
Payment Terms: Cash on Delivery (C.O.D) 30 Days
Mode of Monthly Statement: E-mail Mail Both
E-mail Address for Monthly Statement:
How did you hear about Supagas?:*  Flyer  Internet  Trucks / Ute  Referral  Sales Rep  Tradeshow  Shop-a-docket  Newspaper
 Radio;  Yellow / White pages  Yellow / White pages online  Billboard  Other

Please specify:
Nearest Supagas Branch:  Ingleburn (NSW)  Wollongong (NSW)  Newcastle (NSW)  Beenleigh (QLD)  Canberra (ACT)
Gas Interested in: *  Industrial    Hospitality    LP Gas    Heaters & HeatagasTM
Please specify which gases:*
 
I understand and agree to the terms & conditions*