Apply for a Dealer Account

Please complete the form below. By submitting, you confirm you’ve read and agree to our Terms & Conditions of Trade.

Entity details Applicant’s full legal name Trading as

Business type Years in business

Physical address Postal address

Telephone Email

Contact name Position

Ownership / Directors Owner/Director 1 Address (Director 1) Owner/Director 2 Address (Director 2)

If Limited Liability Company Registered office address

Date of incorporation Incorporation no. NZBN

Financial & advisors (optional) Shareholders’ funds Paid up capital Accountant Solicitor

Bank Branch Account no.

Trade references

Company 1 Contact name

Phone Email

Account open since

Company 2 Contact name

Phone Email

Account open since

General description of goods/services to be provided I agree to the Terms & Conditions of Trade.

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