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$ D : CREDIT ACCOUNT APPLICATION
To Be Completed By Applicants - Please complete all sections and read the Terms and Conditions of Trade overleaf.
DATE: REF No.
CUSTOMERS TRADE NAME:
CUSTOMERS FULL or LEGAL NAME:
Phone: Fax:
Mobile: Email:
Billing Address: Physical Address:
Postcode: Postcode:
COMMERCIAL CUSTOMERS ONLY
Company Number:
Requested Credit Limit: Date Established:
Contact 1: Contact 2:
Position: Position:
Phone: Phone:
DETAILS OF OWNER (If Sole Trader) PARTNERS (If Partnership) OR DIRECTORS (If Company)
Full Name: Full Name:
Home Address: Home Address:
Postcode: Postcode:
Home Phone: Home Phone:
TRADE REFERENCES
Business Name 1: Business Name 2:
Address or A/C No: Address or A/C No:
Phone: Phone:
Fax: Fax:
I certify that the above information is true and correct and that I am authorised to make this application for credit. I have read and understand the TERMS AND CONDITIONS OF TRADE (overleaf or attached) of Urlich Plumbing Limited which form part of, and are intended to be read in conjunction with this Credit Account Application and agree to be bound by these conditions. I authorise the use of my personal information as detailed in the Privacy Act clause therein. I agree that if I am a director or a shareholder (owning at least 15% of the shares) of the Customer I shall be personally liable for the performance of the Customers obligations under this contract.
SIGNED (UPL): SIGNED (CUSTOMER):
Name: Name:
Position: Position:
ID: DOB:
WITNESS TO CUSTOMERS SIGNATURE:
Signed: Name: Date:
Urlich Plumbing Limited
PO Box 12549, Chartwell, HAMILTON 3248 - Ph (07) 855 1391 - Fax (07) 855 1399
Email upl.office@gmail.com
HYPERLINK "http://www.eccreditcontrol.co.nz" www.eccreditcontrol.co.nz EC Credit Control Ltd - 2011
LegalName T/A CustomerName
Address1, Address2, Address3 PostCode, Ph Phone - Fax Fax
Email TOTEmailAddress, Web Website
HYPERLINK "http://www.eccreditcontrol.co.nz" www.eccreditcontrol.co.nz EC Credit Control Ltd - 2011
CustomerName
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