Credit Application Form

Please complete all sections and read the Terms and Conditions of Trade here.

Date(Required)

Client's Trading Name(Required)

Client's Legal Name(Required)

Phone(Required)

Mobile(Required)

Email(Required)

Postal Address(Required)

Address Line 1 Address Line 2 City ZIP / Postal Code

Physical address same as postal address

Physical Address

Address Line 1 Address Line 2 City ZIP / Postal Code

Commercial Clients(Required)

Sole Trader

Partnership

Company

Trust

Company Number

Date Established(Required)

Contact 1(Required)

Contact 1 Position(Required)

Contact 1 Phone(Required)

Contact 2

Contact 2 Position

Contact 2 Phone

Accounts Receivable Email

Accounts Payable Email

Do you require purchase order numbers?(Required)

Yes

Email address for purchase order numbers

Details of: Owner (If Sole Trader), Partners (If Partnership), Directors (If Company), Trustees (If a Trust)

Full Name(Required)

Home Address(Required)

(Driver Licence, Passport, Birth Certificate)

Date of Birth(Required)

Home Phone(Required)

Full Name

Home Address

(Driver Licence, Passport, Birth Certificate)

Date of Birth

Home Phone

Trade References:

Business Name(Required)

Address or Account Number(Required)

Phone(Required)

Email(Required)

Business Name(Required)

Address or Account Number(Required)

Phone(Required)

Email(Required)

Business Name(Required)

Address or Account Number(Required)

Phone(Required)

Email(Required)

You certify that all information supplied is true and accurate and that you are authorised to make this application for credit. You have read and understand the Terms and Conditions of Trade (over the page or attached) of Mighty Kiwi Commercial which form part of, and are to be read in conjunction with this Credit Application Form. You agree to be bound by the Terms and Conditions (over the page or attached) of Mighty Kiwi Commercial and authorise the use of your personal information as detailed in the Privacy Act 2020 clause.

Signed (Client)

Date(Required)

Full Name(Required)

Position(Required)

Date of Birth(Required)

Driver's License No(Required)

Signed (Contractor)

Name(Required)

Date(Required)

Name

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