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Trade Account Application

Reason for completing the credit account application form

Reason

Update Existing Account Open New Account Change of Legal Entity e.g. Sole Trader to Company

Indicate the legal entity of your business

Legal Entity

Company Partnership / Other Sole Trader

SECTION 1 • Customer Details

Applying for credit is:

Trading Name (if any):

Time in Business (years):

Estimated Monthly Spend:

Type of business carried out by Customer:

Postal Address

Street

Suburb

City

Postcode

Delivery Address

Street

Suburb

City

Postcode

Primary Business Contact

Name

Phone No:

Email:

Purchasing Contact

Name:

Phone No:

Email:

Accounts Contact

Name:

Phone No:

Email:

SECTION 2 • Sole Trader

Home Address:

Date of Birth:

SECTION 3 • Company

Company No:

Date of Registration:

Paid Up Capital / Shareholders Funds:

Name and Address of Current Directors

Director 1 Name:

Director 1 Home Address:

Director 1 No. of Shares Held:

Director 1 Date of Birth:

Director 2 Name:

Director 2 Home Address:

Director 2 No. of Shares Held:

Director 2 Date of Birth:

Director 3 Name:

Director 3 Home Address:

Director 3 No. of Shares Held:

Director 3 Date of Birth:

SECTION 4 • Partnership / Other form of Customer

Type of legal entity the Customer is:

Date Customer commenced business:

Name & Address of Partners/Proprietors or Others:

Partner/Proprietor 1 Name:

Partner/Proprietor 1 Home Address:

Partner/Proprietor 1 Shares in Partnership:

Partner/Proprietor 1 Date of Birth:

Partner/Proprietor 2 Name:

Partner/Proprietor 2 Home Address:

Partner/Proprietor 2 Shares in Partnership:

Partner/Proprietor 2 Date of Birth:

Partner/Proprietor 3 Name:

Partner/Proprietor 3 Home Address:

Partner/Proprietor 3 Shares in Partnership:

Partner/Proprietor 3 Date of Birth:

SECTION 5 • Credit References

Reference 1 Business Name:

Reference 1 Account No:

Reference 1 Phone No:

Reference 1 Business Type & Trading History (Years):

Reference 2 Business Name:

Reference 2 Account No:

Reference 2 Phone No:

Reference 2 Business Type & Trading History (Years):

Reference 3 Business Name:

Reference 3 Account No:

Reference 3 Phone No:

Reference 3 Business Type & Trading History (Years):

SECTION 6 • Personal Guarantee and Indemnity

If the Customer is a company, you must provide guarantors acceptable to Workplace Safety Ltd. We recommend that guarantors obtain independent legal advice before signing this guarantee and indemnity.

To complete this section please download this complete the Personal Guarantee document and send a scanned copy of the physical document to accounts@workplacesafety.net.nz.

SECTION 7 • Application, Declaration and Authorisation

1) I have read the Terms of Trade included in this application form. I and the Customer agree that these Terms of Trade apply to the supply of goods by Workplace Safety Ltd (“the Company”) to the Customer. In particular, the Customer agrees that:
(a) payment is due by the 20th day of the month following the month in which the goods are delivered;
(b) the Company retains ownership of the goods pending full payment;
(c) the Customer grants the Company a security interest over the goods as security for payment and the Company may register a financing statement regarding that security interest; and
(d) the Customer waives its right to receive a verification statement regarding any financing statement or financing change statement relating to the security interest.
2) Where the Customer is a company or other legal entity, I warrant that I have authority to sign this credit application form, make this declaration and enter into a binding contract with the Company on the Customer’s behalf.
3) I and the Customer authorise the Company to collect, hold and use personal information about the Customer and any guarantor, director or shareholder of the Customer in accordance with the clause headed “Privacy” in the Terms of Trade included in this application form. In particular, I and the Customer authorise the Company to:
(a) obtain from any credit reference agency information concerning the credit history of the Customer and any guarantor, director or shareholder of the Customer;
(b) disclose credit related information to any credit reference agency for its database concerning the Customer and any guarantor, director or shareholder of the Customer;
(c) use the credit reporting services of any credit reference agency on a continuing basis, at the Company’s discretion, concerning the credit worthiness of the Customer and any guarantor, director or shareholder of the Customer; and
(d) send promotional material or information about the Company’s products and services to the Customer (except where the Customer has advised the Company in writing that it does not want to receive such information).
4) The Customer agrees that it remains liable to pay the full amount owing on its credit account, even if that amount exceeds any approved credit limit.
5) I declare and warrant that the information provided in this application form is true and correct in every respect. I apply on behalf of the Customer to open the credit account according to these terms.

I have read and agree to the T&C's