Resolve Tier One Application - Assure Global Plus Pty Ltd

Resolve Tier One

Completing the application form below allows Assure Global Plus act on your behalf for the recovery of your business's outstanding debts

Select Resolve Package *

Assure Resolve Tier One
Assure Resolve Tier Two
Assure Resolve Tier Three

Business/Company Details

Please select your business type *

Company
Individual/Sole Trader
Other

Company/Business Name/Individual *

ACN

ABN *

Company/Branch Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Business Phone

Mobile *

Website / URL

Bank Account Details

Bank account details are required for recoveries payments to your business account. While not mandatory for the application, your business bank account details will be required for payments to you once we commence recoveries activity.

Account Name

Please enter your business bank account name

Bank & Branch

Please enter your business's bank name and Branch (e.g. Westpac, George Street Parramatta Branch)

BSB

Please enter your bank's Business Service Branch (BSB) number

Account Number

Please enter your business's bank account number

Agreement

The Agent adheres to the Privacy Act 1988 (As amended) and the Australian Privacy Principles. Any information collected will be used only for the purpose for which it is collected, unless otherwise authorised by the client.

I hereby authorise Assure Global Plus (NCI Group Australia Pty Ltd T/as) to act on our behalf for the collection of accounts and in the matters relating to all collections and legal action deemed necessary as instructed to recover monies due and owing.

Terms and Conditions *

I agree to the Terms and Conditions in the link at the top of this page for the appointment of Assure Global Plus (NCI Group Australia T/as) as the Commercial Agent

Name *

First

Last

Position *

Please enter your job role/title

Date *