BSP Fuels Credit Account Application
To be completed by applicants - Please complete all sections and read the Terms and Conditions of Trade
Customer's Details
*
Individual
Sole Trader
Trust
Partnership
Company
Other
Full or Legal Name
*
Trading Name (If different from above)
Physical Address
*
Street Address
Street Address Line 2
City
Region
Postal Code
Billing Address
*
Street Address
Street Address Line 2
City
Region
Postal Code
Email
*
example@example.com
Phone Number
*
Fax Number
Mobile Number
Personal Details show
Personal Details
Please complete if you are an Individual
Date of Birth
Driver’s Licence Number
Personal stopper
Business Details show
Business Details
Please complete if you are a Sole Trader, Trust, Partnership, Company or Other – as specified
Company Number
NZBN
Date Incorp.
Current Owners
Nature of Business
GST Number
if applicable
Paid Up Capital
Estimated Monthly Purchases
Credit Limit Required
Principal Place of Business is
Rented
Owned
Mortgaged (to whom)
Directors / Owners / Trustee
If more than two, please email us the details
1. Name
*
First Name
Last Name
Private Address
*
Street Address
Street Address Line 2
City
State / Province
Postal Code
Date of Birth
*
/
Month
/
Day
Year
Drivers Licence Number
*
Phone Number
*
Mobile Number
*
2. Name
First Name
Last Name
Private Address
Street Address
Street Address Line 2
City
State / Province
Postal Code
Date of Birth
/
Day
/
Month
Year
Driver’s Licence Number
Phone Number
Mobile Number
Business details end
Account Terms
Account Terms
*
20th Month Following
Other
Estimated annual usage
*
in Litres
Purchase Order Required?
*
Yes
No
Accounts to be emailed?
*
Yes
No
Accounts Email Address
*
example@example.com
Accounts Contact
*
Phone Number
*
Bank Account Number
*
Bank and Branch
*
Trade References
Please provide companies that are willing to do trade references
Reference 1
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Email
*
example@example.com
Reference 2
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Email
example@example.com
Reference 3
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Email
example@example.com
Reference End
Upload completed Personal/Directors Guarantee and Indemnity form.
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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 of BSP Services 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.
Customer
*
First Name
Last Name
Position
*
Date
*
-
Day
-
Month
Year
Signature
*
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