Application form

ACCOUNT APPLICATION FORM

APPLICANT FULL LEGAL NAME (i.e. not trading name):

(Please tick)

Sole Trader

Individual

Partnership

Ltd Company

Other (please state):

Trading as:

Postal Address:

Physical Address:

Email:

Nature of Business:

Years in Business:

Telephone:

Fax:

Date of Birth:

Contact Name & Position:

OWNERSHIP please insert Owner(s) / Directors Name(s) in full

Address:

IF LIMITED LIABILITY COMPANY - Address of Registered Office:

Date of Incorporation:

Incorporation No:

FINANCIAL & PROFESSIONAL ADVISORS

Name of Accountant:

Solicitor:

Bank:

Branch:

Acct No:

TRADE REFERENCES

Company

Contact Name

Phone Number

Account open since

Company

Contact Name

Phone Number

Account open since

Company

Contact Name

Phone Number

Account open since

General Description of Products and Services to be provided:

I/We have read and agree to be bound by the terms and conditions of trade as printed overleaf or attached. I/We warrant to Fencing New Zealand Limited that the above information is to the best of my/our knowledge, information and belief true and correct and that I/we am/are duly authorised to enter into this application and future contracts on behalf of the Customer . I/we also acknowledge that pursuant to the personal guarantee contained in the terms and conditions of trade that, where relevant, I/we am/are also signing this application form in my/our personal capacity.

Signed

Accepted file types: jpg, jpeg, png, gif.

Print Name

Designation

Dated this

day of

1. If the applicant is a company then this application form must be signed by a company director of the company.

Terms and Conditions

Terms and Conditions(Required)

Confirm you have read the terms and conditions

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