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Company Name*

ABN*

Please select one*

GST Registered

Not GST Registered

Hobby Farmer

Trading Name

Property Name (if applicable)

Postal Address*

Town

Contact Person (livestock)*

Phone*

Email*

P.I.C*

Accounts Contact Name

Accounts Email (if different to above)

Accounts Phone (if different to above)

Bank details for payment of livestock:*

Kellco Agent

By submitting this form I hereby give permission for Kelly Cavanagh Pastoral Agencies Pty Ltd trading as Kellco Rural Agencies to produce account sales on my behalf for the abovenamed account under the following terms and conditions.

Kellco Rural Agencies may issue Account Sales (RCTI), on my behalf, in respect of supplies made by me, where appropriate
I shall not issue Tax Invoices in respect to supplies made by me where Kellco Rural Agencies has produced an Account Sale on my behalf.
I acknowledge that the information contained in this form is true and correct and ackowledge that I will notify Kellco Rural Agencies of any changes to my status