Account Application

    Applicant's full legal name *

    Applicant type

    If other, please state:

    Trading as

    Postal address

    Physical address

    Email address *

    Contact name & position

    Phone Number

    Mobile number

    Fax number

    Date of birth - provide a copy of passport or motor vehicle license

    If a limited liability company

    Address of registered office

    Date of incorporation

    Incorporation number

    Ownership

    Full details of Directors

    Director 1 name

    Director 1 address

    Director 1 phone

    Director 2 name

    Director 2 address

    Director 2 phone

    Director 3 name

    Director 3 address

    Director 3 phone

    Financial and professional advisors

    Accountant name

    Solicitor

    Bank

    Branch

    Account number

    Trade references

    Company

    Contact name

    Phone number

    Account open since

    Company

    Contact name

    Phone number

    Account open since

    Company

    Contact name

    Phone number

    Account open since

    General description of services to be provided

    I warrant to PlumbGas Systems Ltd trading as Laser Plumbing East Tamaki:

    1. that the above information is to the best of my knowledge, information and belief true and correct; and

    2. that I have carefully read and agree to be bound by the terms and conditions as printed overleaf; and

    3. that I am duly authorised to make this credit account application on behalf of the applicant and of anyone duly authorised to enter into future contracts on behalf of the applicant.