Account Application Form - Concept Construction

P O Box 204122, Highbrook, Auckland Tel: 021 131 9301

Credit Account Application Form

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

Entity Details*

The Customer (Please tick)*

Sole Trader

Individual

Partnership

Ltd Company

Other (please state)

Other:*

Trading as*

Postal Address*

Physical Address*

Registered Office*

Company No*

Nature of Business*

Years in Business*

Telephone Business*

Mobile*

Fax

Email*

Purchasing Contact Name*

Phone No*

Accounts Payable Contact*

OWNERSHIP: (Please insert Owners/Directors names in full}*

Name

Address

Name of Accountant*

Phone No*

Name of Solicitor*

Phone No*

TRADE REFERENCES: (no fuel companies or utility companies)*

Company

Phone Number

Account Open Since

E-signature Attachment*

Max. file size: 64 MB.

Print Name*

Designation*

Date*

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