Apply for a Trade Account

1
Company

2
Technical

3
Accounts

4
Directors

5
References

6
Declaration

Company Details

Tell us about your business and primary contact details.

Company Name * Trading Name Company / NZBN Type of Business * Estimated Monthly Credit ($) * Postal Address * Street Address * Phone * Fax (optional)

Who should we contact for operational or technical matters?

Name * Position * Phone * Mobile * Email *

Who should we contact for invoicing and account matters?

Name * Position * Phone * Mobile * Email *

Please provide at least one director.

Full Name * Address * Position * Full Name Address Position Full Name Address Position

Please provide three suppliers you currently purchase from.

Company * Contact * Phone * Email *

Company * Contact * Phone * Email *

Company * Contact * Phone * Email *

Review before submitting

Please review our Terms & Conditions and Privacy Policy before completing your declaration.

Signatory Full Name * Date *

Submitting this form does not automatically grant credit approval. Applications are subject to review and verification.