Credit Account Application Form

To Be Completed By Applicants - Please complete all sections and read the Terms and Conditions of Trade overleaf or attached. This is a Credit Account Application Form under the Construction Contracts Act 2002. Please read clause 18 on the reverse.

Client's Details: *

IF Other:

Full or Legal Name: *

First

Last

Trading Name: (If different from above)

Physical Address: *

Address Line 1

City

State / Province / Region

Postal Code

Country

Billing Address: *

Address Line 1

City

State / Province / Region

Postal Code

Country

Email Address: *

Phone No:

Fax No:

Mobile No: *

Personal Details: (please complete if you are an individual)

D.O.B.

Driver's Licence No:

Business Details: (please complete if you are a Sole Trader, Trust, Partnership, Company or Other – as specified)

Company Number:

Date Incorp. (current owners):

Nature of Business:

GST No: (if applicable)

Paid Up Capital: $

Estimated Monthly Purchases: $

Credit Limit Required: $

Principal Place of Business is:

IF Mortgaged (to whom):

Directors / Owners / Trustee

Director 1:

(1) Full Name:

First

Last

(1) D.O.B.

(1) Private Address:

Address Line 1

City

State / Province / Region

Postal Code

Country

(1) Driver's License No:

(1) Phone No:

(1) Mobile No:

Director 2:

(2) Full Name:

First

Last

(2) D.O.B.

(2) Private Address:

Address Line 1

City

State / Province / Region

Postal Code

Country

(2) Driver's License No:

(2) Phone No:

(2) Mobile No:

Account Terms:

IF Other:

Purchase Order Required?

Accounts to be emailed?

Accounts Email Address:

Accounts Contact

Phone No:

Bank and Branch:

Account No:

Trade References: (please provide companies that are willing to do trade references)

Reference 1:

1. Name

1. Address

Address Line 1

City

State / Province / Region

Postal Code

Country

1. Phone

1. Fax

1. Email

Reference 2:

2. Name

2. Address

Address Line 1

City

State / Province / Region

Postal Code

Country

2. Phone

2. Fax

2. Email

Reference 3:

3. Name

3. Address

Address Line 1

City

State / Province / Region

Postal Code

Country

3. Phone

3. Fax

3. Email

I certify that the above information is true and correct and that I am authorised to make this application for credit. I have read and understand the TERMS AND CONDITIONS OF TRADE (linked here) of Campbell Plumbing and Gasfitting Limited which form part of, and are intended to be read in conjunction with this Credit Account Application and agree to be bound by these conditions. I authorise the use of my personal information as detailed in the Privacy Act clause therein

Terms & Conditions *

I Agree to Terms & Conditions

Name *

First

Last

Position *

Date *

Date

Time

52995

Click to Call Campbell Plumbing, Gasfitting and Drainlayers

Campbell Plumbing and Gasfitting

Certified Plumbers, Gasfitters and Drainlayers servicing Auckland Central, West Auckland, North Shore Auckland, and South Auckland.
For maintenance and emergency jobs call 0800 226 427 for urgent same day or ASAP service.

For small to large projects, call 0800 226 427 or email admin@campbellplumbing.co.nz to arrange a free quote.

Click to view our pricing guide, and residential and commercial projects.

OUR SERVICES:

Plumbing

How Water Systems

Gasfitting

Drainage

Pricing Guide

Call free today 0800 226 427

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admin@campbellplumbing.co.nz

Credit Account Application Form

Personal Details: (please complete if you are an individual)

Business Details: (please complete if you are a Sole Trader, Trust, Partnership, Company or Other – as specified)

Directors / Owners / Trustee

Director 1:

Director 2:

Trade References: (please provide companies that are willing to do trade references)

Reference 1:

Reference 2:

Reference 3:

Campbell Plumbing and Gasfitting

OUR SERVICES:

Plumbing

How Water Systems

Gasfitting

Drainage

Pricing Guide

We Accept

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