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Online Credit Application (Company)
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Online Credit Application (Company)
Who is completing this Application?*:
Registrant Email*:
Job Title*:
Confirmation of Authority*:
Yes
No
Date of Authority:
Application Agreement*:
This online application form must be completed by all new customers who wish to purchase goods and services on credit terms. It collects all the necessary information required by Absorb to set up your account, or your company's account, if your application is approved.
If your application is approved and credit terms are granted, payment will be due on or before the 20th of the month following the invoice date, without exception. Late or missed payments will result in your account being switched to a cash sale status.
Your monthly credit limit will be established based on your requested amount. Any orders exceeding this limit will require approval from Absorb's management.
Information Required
When completing this form, you will need to provide both personal and/or company details.
Please confirm your understanding and agreement to continue the registration.
Yes
No
Company Information
Company:
Physical Address:
Trading Name:
Are Purchase Orders Required*:
Yes
No
Phone Number*:
Company, Trust, Partnership Credit Limit*:
$1,000
$5,000
$10,000
$15,000
$20,000
> $25,000
GST Number (Company)*:
Postal Address:
Company Email:
Company Number*:
NZBN Number*:
Name of Accounts Payable Contact*:
Phone Number of Accounts Payable Contact*:
Email of Accounts Payable Contact*:
Do you have a Privacy Officer?*:
Yes
No
How did you hear about Absorb?*:
Google
Referral / Word of Mouth
Vehicle Signage
Website
Long-time Customer
Other
Privacy Officer Name, Phone, Mobile and Email:
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