APPLICATION

To:

Go Fresh

Financial Controller

PO Box 197

Brisbane Market Qld 4106

I / We agree for all payments by Go Fresh (ABN: 43 413 852 486) for goods and

services received to be effected by Electronic Funds Transfer to the following

account:-

Go Fresh Vendor #:

Vendor Trading Name:

Vendor Address:

State

Post Code

Vendor Phone #:

Bank Name:

Bank Address:

State

Post Code

BSB #:

Bank Acc. #:

Name of Bank Account:

Go Fresh is under no obligation to verify the above bank account details and

changes in the above particulars must be notified to Go Fresh in writing within

3 days of said changes taking affect.

Signature:

Printed Name:

Title / Position:

Date:

Print form - Complete form - Fax completed form to 07 3319 6326 or post to address above.