BEERTIQUE NZ LIMITED - NEW ACCOUNT APPLICATION
Please complete all information as required:
Email address
Full Legal Name:
Trading As:
Type of Business
Delivery Address
Postal address:
Telephone number:
GST Number:
Name of Person Responsible for Ordering
Email address of Person Ordering
Authorised to Order Online with Beertique via our tradegecko platform
Required
Purchase Order Required
Required
Accounts Payable Name:
Accounts Payable Email:
For Limited Liability Companies (list shareholders/directors below):
References: Name, address and phone no. of TWO principal suppliers (not utility companies)
Declaration by Credit Applicant – We hereby request you open a credit account (full name of authorised person)
Director’s/Partner’s /Authorised Officer Declaration: I, being an authorised Officer of this business, do agree that payment of all accounts will be received by Beertique NZ Limited (our supplier) within your stated credit terms. I/We appreciate that adherance to this obligation is the essence of the contract between us. I/We authorise you to obtain any information that is necessary to evaluate mine/our credit worthiness. I/We accept that if we fail to pay out account, Beertique NZ Limited are authorised to pass information to an outside agent to assist in recovery.
Required
Full Name and Title
Date
MM
/
DD
/
YYYY
Unit 1 - 230b Neilson Street, Onehunga, Auckland +64 9 622 2825
A copy of your responses will be emailed to the address you provided.
Please complete the captcha before submitting the form.
Submit
Never submit passwords through Google Forms.
This form was created inside of Beertique NZ Limited. - Terms of Service - Additional Terms