Credit Account Application – Carolina Trading

Email address*

First name*

Last name*

Company name*

Phone*

Delivery address

Address*

Street Address Address Line 2 Town / City Region ZIP / Postal Code Country

Is your delivery address in a rural area?*

Yes

Postal address

Is your postal address different from your delivery address?

Yes

Address*

Street Address Address Line 2 Town / City Region ZIP / Postal Code Country

Business structure and details of the owners

Business structure*

Sole Trader

Partnership

Company / Directors

Year Started Trading*

GST Number (If applicable)

NZBN (New Zealand Business Number)

Business type*

Physical store

Online

Both

Website

Short description of business

Owner/Partner/Director details

Full name*

Home address*

Street Address Town / City Region ZIP / Postal Code Country

Home phone

Second Partner/Director details

Home address

Street Address Town / City Region ZIP / Postal Code Country

Home phone

Billing contact

Contact person – Purchases

Contact person – Accounts Payable

Account & Credit Information

Expected Monthly Spend*

Apply for Credit Account?*

Yes

Reference 1

Business name*

Phone*

Address

Street Address Town / City Region ZIP / Postal Code Country

Reference 2

Business name*

Phone*

Address

Street Address Town / City Region ZIP / Postal Code Country

Declaration & Authorisation

Confirmation*

I/We have read and agree to be bound by the terms and conditions. I/We warrant to Carolina Trading NZ Ltd. that the above information is to the best of my knowledge, information and belief true and correct and that I/we am duly authorized 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 also bound by this application form in my/our personal capacity.

Name*

Position*

Name

Position

Confirmation*

I have read and accepted the terms and conditions.