ARGON CREDIT ACCOUNT APPLICATION

CREDIT ACCOUNT APPLICATION
Argon Distributors Limited T/A Argon Distributors
Postal Address: PO Box 13993, Onehunga, AUCKLAND 1643.
Physical Address: 7 Monier Place, Mount Wellington, AUCKLAND 1060
Phone: (09) 634 3415 Email: accounts@argon.nz Web: www.argon.nz
To Be Completed By Applicants - Please complete all sections and read the Terms of Trade
Full or Legal Name
Trading Name If different from above
Physical Address
Postcode
Email Address
example@example.com
Phone No
Mobile No
Personal Details: (please complete if you are an Individual)
Date of Birth

MonthDayYear
Drivers Licence No
Version
Business Details: (please complete if you are a Sole Trader, Trust, Partnership, Company or Other - as specified)
Company Number / NZBN
Length of time in business
Credit Limit Required: $
Directors Owners Trustee if more than two please submit a separate form
(1) Full Name
Date of Birth

MonthDayYear
Address
Postcode
Drivers Licence No
Version
Phone No
Mobile No
(2) Full Name
DOB
Address
Postcode
Drivers Licence No
Version
Phone No
Mobile No
Account Details: Billing Address
Postcode
Purchase Order Required?

YesNo
Accounts to be emailed?

YesNo
YES
Accounts Email Address if different to above
example@example.com
Accounts Contact
Phone No
Trade References: (please provide companies that are willing to do trade references)
(2) Name
(2) Address
(2) Phone / Email
(3) Name
(3) Address
(3) Phone / Email
(1) Name
(1) Address
(1) Phone / 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 of Trade (click on the link) of Argon Distributors Limited T/A Argon Distributors which form part of and are intended to be read in conjunction with this Credit Account Application and agree to be bound by those terms. I authorise the use of my personal information as detailed in the Privacy Act clause therein.
YOUR SIGNATURE

Clear
Name
Position
Date

MonthDayYear
Date
OUR SIGNATURE

Clear
Name
Position
Date

MonthDayYear
Date
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CREDIT ACCOUNT APPLICATION

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)

YES

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