Credit Application Form

TO BE COMPLETED BY THE CUSTOMER

Registered Name *

Trading Name *

Registration Number

Business Type / Main Activity *

Number of Employees

Street Address *

City *

State/Province *

ZIP / Postal Code *

Account Information - Ownership

Director 1 / Partner / Sole Trader / Individual

Full Name *

Date of Birth *

Day *

Month *

Year *

Street Address

City

State/Province

ZIP / Postal Code

Director 2 / Partner

Full Name

Date of Birth

Day

Month

Year

Street Address

City

State/Province

ZIP / Postal Code

Accounts Department Contact

Contact Name *

Position *

Phone Number *

Email Address *

Registered for GST? *YesNo

Credit Limit Requested

Delivery Details

Delivery Contact Name *

Street Address *

City *

State/Province *

ZIP / Postal Code *

Authorisation - I agree to the following:

Authorisation *I hereby apply to open a credit account with Kiwi Hygiene Supplies Limited.I have read and fully understand Kiwi Hygiene Supplies Limited Terms & Conditions and commercial credit accounts for this business entity.The signatory below warrants that the information in this application is true and accurate, and they have authority to sign this document for this business entity.Please read, sign and date below – I have read and fully understand Kiwi Hygiene Supplies Limited’s Terms and Conditions of the Trade and agree that they will apply in respect of all contracts for the supply of goods by Kiwi Hygiene Supplies Ltd to the Customer.

Authorised Signatory: (Authorised Person, Director, Partner or Trustee) *

Position *

Date Signed *

Day *

Month *

Year *

Credit ReferencesBusinesses who can tell us about your trading history (excluding utilities, lawyers, accountants or banks)

Business Name *

Contact Name *

Phone *

Monthly Spend *

Disclamer

All electronic communications regarding the setup and use of a business account are subject to the provisions of the Electronic Transactions Act 2022.

Disclosure: Credit applications take between 3 and 5 days to be processed. We will email you with your account details if approved. If we require further information to complete our assessment of your application, we will contact you directly.

If you require further your application to be expedited, please contact Kiwi Hygiene Supplies:

admin@kiwihygienesupplies.co.nz OR phone 0800 111 565

🇳🇿 NZ nationwide delivery - Free shipping on orders over $100

Business Account Application Form

Account Information - Ownership

Authorisation

Join Our Newsletter Community

🇳🇿 NZ nationwide delivery - Free shipping on orders over $100