Account Application

ENTITY DETAILS

(All fields must be completed before this application can be processed)

Applicant’s full legal name *

Trading As (where applicable) *

Ltd Company

Individual

Other (please state)

Details

Postal Address *

Postal Code *

Physical Address *

Contact Details

Business Phone *

Mobile Phone *

Contact (Accounts)

DDI *

Email *

Email Address for Invoices/Statements *

Credit Limit Requested *

Order No *

Yes (state format)

Order No Format

NZ Business Number *

Nature of Business *

Years in Current Business *

COMPANY PARTICULARS

(Please attach separate details if more than three Director(s)/Partner(s)/Trustee(s))

Details of the Director 1

Directors’ Full Names *

Residential Address *

Phone *

DOB *

Details of the Director 2

Directors’ Full Names

Residential Address

Phone

DOB

Details of the Director 3

Directors’ Full Names

Residential Address

Phone

DOB

Please note that we may request further financial information to enable better assessment of credit risk

Have the company or its directors ever been served with a statutory demand or other proceedings in relation to recovery of debt? *

Yes (please provide details)

Details

TRADE REFERENCES

(Please exclude Power Authorities, Phone Companies, Landlords, Banks, Lawyers, and Accountants. Nominate businesses that you have traded with for at least 12 months.)

Trade 1 Details

Name *

Location *

Phone No. *

Trade 2 Details

Name

Location

Phone No.

Trade 3 Details

Name

Location

Phone No.

Declaration Form

The Applicant hereby applies for a Trade Credit Account with Hinemoa Cleanfill in accordance with Hinemoa Cleanfill’s Terms of Trade & Credit attached. The Applicant warrants and represents that all information in this Application is accurate and complete. Hinemoa Cleanfill may refuse this Application at its absolute discretion. Unless otherwise defined, all capitalised terms in this Credit Account Application have the meanings given in Hinemoa Cleanfill’s Terms of Trade & Credit.

Signature *

Tick to Sign

Name *

Position *

Date *

Account Guarantee Form

In the event that Hinemoa Cleanfill (as defined in Hinemoa Cleanfill’s Terms of Trade & Credit) agrees (in its sole discretion and after review of the Customer’s Application) to open a Trade Credit Account for the Customer, the Guarantor(s):

Guarantee (jointly and severally if more than one) repayment to Hinemoa Cleanfill of all amounts payable by the Customer in respect of the Trade Credit Account, and the performance of all of the Customer’s obligations in relation to that Account.
Acknowledges that Hinemoa Cleanfill has opened a Trade Credit Account with the Customer at the request of the Guarantor, and that Hinemoa Cleanfill might not have done so without the Guarantor’s guarantee.
Agrees that if the Customer does not pay any amount, or perform any obligation, in respect of the Trade Credit Account, the Guarantor will do so on demand (without counterclaim or any deduction or set off).
Agrees that if for any reason any amounts payable by the Customer in respect of the Trade Credit Account are not recoverable by Hinemoa Cleanfill, the Guarantor will indemnify Hinemoa Cleanfill against any resulting loss and related costs, and will pay the amount of any such loss to Hinemoa Cleanfill as a principal debtor and on demand.
Agrees that their obligations as a Guarantor are absolute and unconditional, and will not be released or in any way affected by:
- any variation or release of the terms of the Trade Credit Account; or
- any concessions by Hinemoa Cleanfill to the Customer or to any other Guarantor; or
- the insolvency of the Customer or any other Guarantor; or
- any other act, omission, or rule of law which, were it not for this clause, might release a guarantor; and irrevocably waives any rule of law to a different effect.
Acknowledge that Guarantor has been advised to seek independent legal advice in relation to the obligations under this Personal Guarantee and has either done so or elected not to do so prior to signing this Guarantee
Authorises Hinemoa Cleanfill to collect personal information and/or provide personal information relating to the Guarantor to credit reference agencies, referees and other bodies, as Hinemoa Cleanfill considers necessary for the purposes of the Guarantee. The Guarantor has the right to access and correct any personal information held by Hinemoa Cleanfill.

GUARANTORS AND WITNESS TO COMPLETE

Guarantor 1 Details

Name *

Home Address *

Signature *

Tick to Sign

Witness Name *

Witness Signature *

Tick to Sign

Guarantor 2 Details

Name *

Home Address *

Signature *

Tick to Sign

Witness Name *

Witness Signature *

Tick to Sign

Fill in the form below or alternatively you can complete the download form and email it to us.

Credit Account Application

Fill in the form below or alternatively
you can complete the download form and email it to us.