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Clinic/Business Information

Name of the Clinic/Business*
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Business Address

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Credit Application

I/We would like to apply for a credit account:
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Are you the registered owner of the business?
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We will require authorisation from the business owner to proceed with credit account set-up.

Have any of the individuals above been declared Bankrupt?
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Has the business ever been refused credit?
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Credit Application Declaration
I/We hereby apply for credit with Medlab Clinical Limited and certify that the information supplied in this application is true and correct. I/We authorise Medlab Clinical Limited to conduct a Credit History Check with an external Credit Agency. I/We understand that all information will be treated as confidential and will not be supplied to any other organisation.

Patient Billing

If you do not have a dispensary and are interested in patient billing, a Medlab Practitioner consultant will be in contact with you.

I would like to set-up a patient billing account:
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I / We have read and agree to the Terms and Conditions, Terms of Sale and the Medlab Privacy Policy displayed on the Medlab website. I / We agree to comply with and be bound by these policy documents (which may be amended or updated from time to time).

Should you have any enquires on Medlab Clinical Pty Ltd Terms and Conditions, Terms of Sale or Privacy Policy please contact: [email protected] or call 1300 369 570.

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