Credit Application | EMPR New Zealand

Before filling in this Credit Application form please observe these requirements before we can process it. These requirements are put into place as part of our Quality Assurance System.

(a) Your company requires a trading history with EMPR New Zealand, either paid by Credit Card or Direct Deposit.
(b) Trade References need to be Credit type, Not C.O.D. or other forms of Pre-Payment.

I / We the undersigned hereby make application for credit and provide the information contained herein which is warranted to be true and correct, for the purpose of establishing a credit account with EMPR New Zealand.

Fields marked *are required.

Credit Application Type :

Apply for Credit - Resellers, Service Providers, Corporations & Businesses
Apply for Credit - Education and Government

Company Information :

Company*

Trading Name*

Previous Trading

NZBN*

GST Number*

Street*

Suburb*

Region*

Postcode*

Phone*

Fax

Web Address

Director Information :

[1]

Name*

Address*

Suburb*

Region*

Post Code*

Last Three Trade Reference :

[1]

Company*

Name*

Email*

Phone*

Fax*

[2]

Company*

Name*

Email*

Phone*

Fax*

[3]

Company*

Name*

Email*

Phone*

Fax*

Anticipated Monthly Expenditure :

Expenditure $*

$

Accounts Payable Details :

Accounts Payable Name*

Accounts Email*

Accounts Phone*

Your Details :

I / We agree to pay all accounts within the timeframe advised if credit is approved.

I / We also agree to pay any and all legal costs or collection fees and commissions which may be incurred in recovery of any part of this account when it is not paid with in the terms of days as stated above.

I / We understand that the credit facility, if extended, maybe withdrawn at the discretion of the EMPR and that I / We shall be notified of such withdrawal.

Your First Name*

Your Last Name*

Position*

Email*

By submitting this form you are confirming that you have read and understood the Terms & Conditions of EMPR New Zealand.

Credit Application Form