Application for Credit Account

A. APPLICANTS DETAILS

Name or Trading Account:*

Delivery Address:*

Post Code:*

Phone:

Cell:

Billing Address (if different from above):*

Post Code:*

Legal Status (i.e. Sole Trader, Partnership, Limited Liability Company etc):

GST No:

Name of Bank and Branch:

Purchasing Contact Name:

Purchasing Contact Email:

Accounts Contact Name:

Accounts Contact Email:

DIRECTOR or PARNTER/S

Director/Partner Contact Name/s:*

Director/Partner Contact Email/s:*

Director/Partner Ph:*

Residential Address for Partners and/or Directors:*

By signing this document, the Directors of any company personally guarantee to pay any monies owing to Topflite for the purchase of goods under this agreement.

B. CREDIT OR TRADE REFERENCES

Please give a name of firm, location, telephone number and email.

1:	Ph:	Email:

2:	Ph:	Email:

3:	Ph:	Email:

Recommended by:

C. COMMUNICATION PREFERENCES

Email preferences for parcel and delivery tracking updates:*

Email preferences for invoices and statements:*

Would you like to receive marketing updates, promotions & newsletter by email?

Email preferences marketing emails:

D. PRIVACY ACT

This information is being collected by Topflite Ltd for the purpose for processing this application and for future credit reference. The information will be held by Topflite Ltd at 6 Pukeuri-Oamaru Road, RD 1K, Oamaru 9494. Topflite Ltd reserve the right to decline to give credit if information requested is not provided. Pursuant to the Privacy Act 1993 you have the right of access to and correction of your personal information held by Topflite Ltd.

I/We hereby authorise Topflite Ltd to disclose details of this application to any listed creditor trade referee, and for such referee to provide Topflite Ltd with such personal information as they may require to process this credit application and to maintain the accuracy of the information held.

I/We hereby apply to open a Credit Trading Account and agree to the Terms of Trade set out.

To see the Topflite Terms of Trade click here.

Name*

First Last

Position:

Date

Thank-you for your interest in becoming a Toplite retailer. Please note that completion of this form does not guarantee a Credit Account. By submitting this application, you have authorised Topflite to make enquiries into the banking and business/trade references that you have supplied. Our Customer Service team will be in touch within 3-5 working days upon submission of this form.

Name

This field is for validation purposes and should be left unchanged.

A. APPLICANTS DETAILS

DIRECTOR or PARNTER/S

B. CREDIT OR TRADE REFERENCES

C. COMMUNICATION PREFERENCES

D. PRIVACY ACT

Nature. Nurtured.

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