TERMS OF TRADE

Application for Credit Account

Nature of Organisation

Sole Trader
Partnership
Limited Company
Trust
Other

Trade Name

Legal Name

Delivery Address

Postal Address

Telephone

Fax

Mobile

Registered Office

Company Number

Date of Birth (If sole trader)

Previous Address Details
(If less that 2 years)

Identification Type

Identification Number

Details of Partners (if partnership) or details of Directors (If Limited Company)

1. Full Name
Home Address
Home Phone
Date of Birth
2. Full Name
Home Address
Home Phone
Date of Birth

Contact Person for Accounts

Name & Branch of Bank

Bank Account Details

Solicitors Name & Address

Accountants Name & Address

Trade References (Exclude Credit Cards, Fuel Suppliers, Landlord, Power & Phone)

1	Phone
2	Phone
3	Phone

I certify that the above information is true and correct and that I am authorized to make this application for credit. In accordance with the Privacy Act (1993) I authorize any person or company to give information as may be required in response to credit inquires. I have read and understand the GENERAL TERMS AND CONDITIONS OF TRADE of New Zealand Accommadtion Supplier Ltd which form part of, and are intended to be read in conjunction with this Credit Application and agree to be bound by these conditions.

Signed

( Proprietor/ Partner/ Director/ Authorised Signatory)

Date

Full Name

Position

Guarantor Details (if required)
Full Name

Occupation

Address

Signature

I've read and accept NZAS "Terms of Trade" and completed "Application for Credit Account Form" above.