go via Post-paid account application form – 30 day account

Post-paid account application form – 30 day account
Please complete in black or blue pen using BLOCK letters. Print
✗ to mark boxes where applicable.
Section A: Business details
Section D: Security
Business name
Security information is required to ensure that your account is only accessed by
authorised personnel.
Trading as
Please provide a six (6) digit numeric PIN.
Your PIN allows access to your account online or through
our automated phone system.
ABN
x
Would you like us to notify you by email if you forget your PIN?
ACN
Date established
d
d
m
Yes
x
No
If yes, you must provide a valid email address in Section B.
m
y
y
Type of business (e.g. builder, accountant or electrician)
Section E: Statement options
How would you like to receive your statement? Business address
x
Online*Mailed#
x
*We will notify you by email that your statement is ready to view. Please ensure you have provided a valid
email address in Section B.
#
View 18 months of statements at no extra cost online. You will be charged a requested statement fee for each
paper statement that you request from us. Visit govia.com.au for current fees.
Suburb
Section F: Director’s details
PostcodeState
Director 1
Phone 1
x
x
x
x
Mr Mrs MissMs Dr
x
First name
Phone 2
Surname
Fax
x
Is the business address your mailing address?
If not, then complete the following address section.
Yes
x
Address
No
Suburb
Mailing address
PostcodeState
Phone
Mobile
Suburb
PostcodeState
Director 2
x
x
x
x
Mr Mrs MissMs Dr
Section B: Account contact details
x
x
x
x
Mr Mrs MissMs Dr
First name
x
Surname
First name – as per your driver’s licence
Address
Surname – as per your driver’s licence
Suburb
Phone
Phone
Mobile
Mobile
Fax
Email
Would you like to receive marketing updates
and handy tips?
x
Section C: Total monthly estimate
Please indicate the estimated monthly total toll costs for all vehicles. Minimum $5,000 per month.
x
$
x
YesNo
PostcodeState
Section H: How to pay your account [cont.]
Section G: Trade references
Please note that it is mandatory to supply three (3) references.
Credit card
Contact name
To set up an automatic payment using your credit card, for privacy reasons please call us
on 13 33 31.
Business name
Phone
Online
Log on to govia.com.au to make a payment with your credit or debit card.
Fax
Telephone and Internet Banking – BPAY®
Contact name
Biller code: 10306
Business name
Ref: go via account number
Phone
Fax
all your bank or financial institution to make
C
this payment from your cheque, savings,
debit /credit card or transaction account.
More information at www.bpay.com.au
Office use only
Contact name
Account number Business name
Date
d
Phone
Fax
Section H: How to pay your account
Direct debit (automatic account payment)
To set up an automatic payment please complete the following direct debit and send to:
Queensland Motorways Management Pty Ltd
PO Box 2125, Mansfield QLD 4122
x
Direct debit
BSB
Account number
Account name
Name of financial institution
Branch location
I/we (first name/surname)
of (company name if applicable)
Authorise
Queensland Motorways Management Pty Ltd APCA User ID number 068471 to arrange for funds to
be debited from my/our account at the financial institution identified above and as prescribed through
the Bulk Electronic Clearing System. This authorisation is to remain in force in accordance to the terms
described in the Direct debit request service agreement in Section K.
The Debit User (Queensland Motorways Management Pty Ltd) to verify the details of the account details
provided above with my/our financial institution.
The financial institution to release information allowing the Debit User (Queensland Motorways
Management Pty Ltd) to verify the account details provided above.
First account holder’s signature
✗
d
d
m
m
y
y
d
d
m
m
y
y
Second account holder’s signature (if applicable)
✗
d
m
m
y
y
Section I: Vehicle information
Please complete a line for each vehicle you would like registered on your go via account (if you require more vehicles than the space below allows, please complete another form).
Tag required?
LPN*
x
Yes
x
No
x
Yes
x
No
x
Yes
x
No
x
Yes
x
No
x
Yes
x
No
x
Yes
x
No
x
Yes
x
No
x
Yes
x
No
x
Yes
x
No
x
Yes
x
No
x
Yes
x
No
State
Make
Model
Class†
Cost centre
Fleet number
Vehicles without a tag incur an additional video matching fee per toll point. Visit govia.com.au for current fees. *Your LPN is your Licence Plate Number. †Refer to class vehicle diagrams below. For detailed definitions visit govia.com.au
[Class 1] Motorbike
[Class 3] Light Commercial Vehicles
[Class 2] Car
[Class 4] Heavy Commercial Vehicles
Section J: Director authorisation
This application is dated
day of 20
Director 1 name
Director 2 name
Signature
Signature
✗
✗
d
d
m
m
y
y
d
d
m
m
y
y
d
d
m
m
y
y
Witness name
Signature
✗
Section K: Direct debit request service agreement
1. This agreement provides for automatic payments to be made from your nominated bank account for the
purposes of making payments to your go via account with Queensland Motorways Management Pty Ltd.
6. If the due date for payment falls on a non-working day or a public holiday, the payment will be processed on
the next working day.
7. If there are insufficient funds in your nominated account and your bank dishonours a payment then:
Automatic payments will be generated:
a. If your go via account is a pre-paid account, whenever the account reaches the pre-agreed top-up trigger
level; and
b. If your go via account is a post-paid account, 28 days after the end of each month.
This authority will remain in force until its cancellation or the closure of your go via account.
2. You will be advised 14 days in advance of any changes to the Direct Debit arrangements.
3. For all matters relating to the Direct Debit arrangements, you will need to:
• Phone our Contact Centre on 13 33 31; and/or
• Send written correspondence to the company at PO Box 2125, Mansfield, QLD 4122 outlining the request/
issue. This request must include your name, your go via account number and a contact telephone number.
You should allow three working days for any amendments to take effect.
4. You should be aware that:
a. Direct debiting through Bank Electronic Clearing System (BECS) is not available on all bank accounts; and
b. Account details should be checked against a recent statement from your financial institution. If you are in
any doubt, you should check with your financial institution before completing the drawing authority.
5. It is your responsibility to ensure sufficient cleared funds are available in the nominated bank account when the
payments are to be drawn.
• The amount of the dishonoured payment will be debited to your go via account.
• The company reserves the right to debit your go via account any bank charges and costs it may incur as a
result of the dishonour.
• All tags linked to your go via account will be suspended when your go via account is in debit, and will
remain suspended until your go via account is returned to credit.
• The company may take other action contemplated in the terms and conditions applicable to your go via
account: additional fees and charges may apply.
8. All customer records and account details will be kept private and confidential and will only be disclosed:
• If you consent;
• To the extent required by law, for example if a court order requires disclosure; or
• For the purposes of this agreement, for example to settle a dispute.
Section L: Credit application terms and conditions
1General
1.1 Credit application warranty
The Applicant, Directors and Signatory jointly and severally represent and warrant that all information
provided in (or in support of) this Application is true and correct and not misleading or deceptive and
nothing has been withheld which is material to any decision by Queensland Motorways Management Pty Ltd
(QMM) to provide credit and they are duly authorised to apply for credit and to execute this Application. The
Applicant will, upon request by QMM, establish the truth, correctness and completeness of any information
supplied by the Applicant, its Directors and the Signatory. Each of those parties will promptly notify QMM if
there is any change to any of the information provided to QMM. QMM may require proof of identity from the
Applicant, Directors, or Signatory.
1.2Evaluation
QMM’s evaluation of the Applicant’s credit application and the information QMM obtains in connection
with it including trade referees information remain confidential to QMM and will not be released to the
Applicant. QMM may choose to approve or decline an Application at its sole discretion and without giving
any reason to the Applicant.
2.11.1 the composition of the Applicant’s Board of Directors;
2.11.2 control over half the voting rights attaching to shares in the Applicant;
2.11.3 control over half the Applicant’s issued share capital.
2.12Guarantee
The Directors jointly and severally guarantee to QMM the due and punctual performance by the Applicant
of its obligations under these credit terms and under the Customer Service Agreement including all
monies due under those documents or otherwise for the use of the toll roads and indemnify QMM against
any loss or damage (including consequential loss) which QMM may suffer or incur arising out of any breach
by the applicant of any of those documents or arising out of any use or misuse of the toll roads by the
Applicant or its officers, employees, servants or agents.
2.13All monies charge
Applicant and Directors and Signatory jointly and severally charge with payment of any moneys due to QMM
all their respective beneficial interests in realty (freehold and leasehold) and personalty held now or in the
future by anyone or more of them. Applicant, Directors and Signatory agree that if demand is made by QMM
of anyone or more of them, then each person receiving that demand (Recipient) will immediately execute a
mortgage or other instrument of security, or consent to a caveat, as required, and if the Recipient fails to do
so and return the same to QMM within 7 calendar days of the demand being made, the Recipient hereby
irrevocably and by way of security, appoints QMM and every Officer to be severally the true and lawful
attorney of the Recipient to execute and register any such instrument in the place and stead of the Recipient.
2.14Caveat
Notwithstanding any other provision hereof, in addition to clause 2.13, QMM may lodge a caveat noting
the interest given by the charge under clause 2.13 on the title of any property (real or personal) of any
Recipient whenever it wishes to do so.
2.15Costs
Applicant and Recipient are jointly and severally responsible for the costs of anything done under clause
2.13 or 2.14.
2Payment
2.1 Payment terms
Accounts are due and payable in full without any deduction, set-off, counterclaim or condition within
30 days of the end of the month in which the charges arose (Due Date) failing which credit may be
cancelled/suspended without notice.
2.2Trustee
Where the Applicant acts as trustee of a trust, the Applicant will be liable both in its personal capacity and
in its capacity as trustee of that trust.
2.3 Late Payment Fees
1.25% per month calculated daily and compounded monthly is payable on overdue accounts.
2.4 Recovery costs
Applicant must pay any recovery, legal and/or mercantile agent costs or expenses (including dishonoured
cheque or direct debit fees) QMM incurs in collecting moneys owed by the Applicant.
2.5 Adjustments to account
QMM may at any time without notice adjust the Applicant’s account balance to reflect any processing
error, or the dishonouring of a payment, or of any refunds or corrections or other errors or omissions.
2.11Change in control and assignment
The credit facility is personal to, and cannot be assigned by, the Applicant. Any change in control of the
Applicant without prior QMM’s consent is deemed to be an assignment including a change in:
3 Termination of credit
2.6Default
Applicant is in default under these Credit Terms if:
QMM may terminate the credit arrangement with the Applicant at any time by notice to the Applicant without
giving any reason for doing so and whether or not the Applicant is, at the time of termination, in breach of
these Credit Terms or any Customer Service Agreement. QMM is not liable to the Applicant for any termination
or suspension of any credit facility made available to the Applicant.
2.6.1 money owing to QMM is not paid by the Due Date;
2.6.2 anything in this Application is false, incorrect or misleading;
4 Customer Service Agreement
2.6.3 the Applicant breaches its obligations under these Credit Terms or its Customer Service Agreement
with QMM.
2.7 If default occurs, QMM may in its discretion:
2.7.1 suspend and/or revoke the credit accommodation provided and/or require the immediate payment
without deduction or demand of the outstanding balance of the account and all other money owed
under these Credit Terms; and/or
2.7.2 refuse to extend further credit to the Applicant and/or require any further transaction to be on a
cash before delivery basis.
5Disclaimer
5.1 QMM or its holding company, Queensland Motorways Pty Limited, ACN 067 242 513 or any of the other subsidiaries of that holding company are not liable in any way (whether in contract, tort or otherwise)
for any loss or damage (including consequential loss) suffered or incurred by the Applicant or its
Directors in connection with the provision of (or withholding of) credit by QMM to the Applicant including
where any error or omission is made by QMM or where any incorrect entries or omissions are made to the
Applicant’s account.
5.2 QMM does not waive a right, power or remedy hereunder or under its Customer Service Agreement if it
fails to exercise or delays in exercising that right, power or remedy. A single or partial exercise of a right,
power or remedy does not prevent another or further exercise of that or another right, power or remedy.
2.8Evidential
A statement signed by a manager of QMM is prima facie evidence of the facts, matters or things detailed
in it including:
2.8.1 the amount due and owing to QMM;
2.8.2 whether there has been a default in payment;
2.8.3 a notice hereunder being served on the Applicant.
2.9 Joint and several liability
An agreement, representation or warranty by the Applicant and/or Directors and/or Signatory binds them
jointly and severally.
2.10Amendment
QMM may amend these Credit Terms at any time by notifying the Applicant on any statement of account,
invoice or by mail or by publishing them on our website or otherwise. Amended terms apply 7 days from
notice or from any earlier use of credit facilities or toll road by Applicant.
Applicant agrees that all tolling products supplied to Applicant will be supplied on the terms and conditions
of QMM’s Customer Service Agreement for that product which will bind the Applicant subject to any contrary
provision in these Credit Terms. A copy of the terms and conditions may be obtained online at govia.com.au
or mailed by calling 13 33 31.
6 Applicable law
6.1 This Agreement is governed by the laws of Queensland and the Applicant submits to the non-exclusive
jurisdiction of the Courts of that State.
6.2
These Credit Terms do not exclude, limit, restrict or modify any right, entitlement or remedy conferred
on the Applicant under any law where that law has mandatory application. If any of these Credit Terms is
or becomes for any reason wholly or partly invalid, it shall, but only to the extent of that invalidity, be
severed without prejudice to the continuing force and validity of the remaining Credit Terms.
To accept the credit application and terms and conditions please complete the following section. If you do not accept the terms and conditions we will not be able to open an account for you.
Applicant 1
x
Applicant 2
x
x
x
Mr MrsMiss Ms Dr
x
x
x
Name – as per your driver’s licence
Address
Address
Suburb
Suburb
PostcodeState
Applicant 1 signature
x
x
PostcodeState
Applicant 2 signature
✗
✗
d
m
m
y
y
d
d
m
m
y
y
Queensland Motorways Management Pty Ltd
ABN 86 010 630 921
GV018 0316
d
post PO Box 2125 Mansfield QLD 4122
email [email protected]
visit govia.com.au
x
Mr MrsMiss Ms Dr
Name – as per your driver’s licence