New Account Registration Form

ACCOUNT APPLICATION

Please note that you will need to complete and submit this form in order to be eligible for 20th of the month account payment. We require everyone including existing customers to please complete this form. Please read our payment and shipping pages for further information. You can email info@beekindnz.com with any enquiries.
Full Name *

First Name Last Name
Email Address: *
example@example.com
Contact Phone Number *
Registered Business Name: *
Trading name (if different):
NZBN (if applicable)
Are you trading as a Retail or online store? *

Retail (Brick and Mortar) Online only Both Retail and online Other
Registered Business Address *

Street Address

Street Address Line 2

City State

Zip Code Country
Shipping Address (If different to above)

Street Address

Street Address Line 2

City State

Zip Code Country
Business website (if applicable)
Please link to your Facebook, Instagram and any other social media platforms you have (if applicable)
Please provide any other relevant information about your business: (i.e how long you have been trading, why you believe our products are a good fit, what your customer base is, etc.) *
Please provide contact details (email or phone) for an emergency contact: *
Should be Empty:

ACCOUNT APPLICATION