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.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of Beertique NZ Limited. - Terms of Service - Additional Terms