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Credit Account Application Form 
Please note: Credit accounts are created for Clients with an average monthly spend of more than $500.00
Business Details:
Company Name   
New Zealand Business Number (NZBN)   
Established for     Years
Monthly credit limit requested ($)   
 
Billing Address:
Address   
 
Suburb   
Regions   
PostCode   
 
Contact Details:
First Name   
Surname   
 
Mobile   
Phone     
Fax     
Email Address   
 
Director/Owner:
First Name   
Surname   
 
Mobile   
Phone     
 
Credit References:
Company Name (1):
Contact Name:
Phone:
 
Company Name (2):
Contact Name:
Phone:
 
Further Comments:
 
By submitting this application you are stipulating that you are an authorised representive of your organisation and that all information you have provided is, to your knowledge, accurate.
 
Security code Type code here

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