Open an Account

Please complete the following form in full

 

COMPANY DETAILS

 

 

Registered Name of Company:
Trading Name of Company:
Nature of Business:
Physical Address:
Postal Address:
Length of Time in Business:
Company Accountant:
Accountant Phone:

 

 

Contact Details 

 

Contact Name:
Phone:
Mobile Phone:
E-mail:
Account Contact:
Account Phone:
Account E-mail:  
Approx spend per month:  

 

 

Trade References
Please provide three

 

Reference 1:
Name, Address, E-mail & Phone
Reference 2:
Name, Address, E-mail & Phone
Reference 3:
Name, Address, E-mail & Phone

 

 

PERSONAL DETAILS (If Sole Trader/Partnership)

 

 

Surname:
First Names:
Private Address:
Phone Number:
Date of Birth:

 

 

Applicant 2 - If Partnership

 

Surname:
First Names:
Private Address:
Phone Number:
Date of Birth:

 

 

Our preference is for invoices to be paid by direct credit:
BNZ Sydenham 02 0828 0309673 00

 

Please advise how you will be paying:
Direct Credit    By Mail    Over Counter

 

 

If Referred by CQ Staff Member Please Put Name Here:

 

 

 I have read and agree to the terms and conditions of account

 

 

  

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