I consent to SURGICO Instruments collecting information about me, including information about my creditworthiness, credit history, credit standing, credit capacity or other credit information (“Credit Information”) from credit reporting agencies, or from any credit provider or trade referee named in this application or named in a credit report.

I consent to the SURGICO Instruments using the Credit Information, and other information about me collected by the Company: (a) to assess this application; (b) to assess my creditworthiness or the creditworthiness of the Customer; (c) for the purpose of collecting payments overdue in respect of commercial credit and to otherwise assist the Customer to avoid default; or (d) for the purpose of assessing whether to accept me or another individual as a guarantor.

I consent to SURGICO Instruments disclosing the Credit Information, and other information about me collected by SURGICO Instruments, to credit reporting bodies; to debt collectors; to credit providers; to any individual who is a guarantor or potential guarantor of my obligations to SURGICO Instruments; to any individual who is considering whether to offer property as security for my obligations to SURGICO Instruments; to any related entity of SURGICO Instruments; to any agent or contractor of SURGICO Instruments (including legal advisors and mercantile agents); and to other parties authorized or required to collect that information.

On behalf of the Customer, I agree that all goods and services will be supplied by SURGICO Instruments on the Terms and Conditions of Trade and as varied and applicable from time to time. The Terms & Conditions of Trade have been read on behalf of the Customer before signing this declaration. The Terms & Conditions of Trade may be varied with written notice.

I warrant that: (a) the information in this application is true and correct; (b) I am authorized to complete and submit this application on behalf of the Customer.