General Cargo Credit Account Application Form

    BUSINESS CONTACT INFORMATION

    Title:

    Company name *:

    NZBN *:

    Phone *:

    Fax:

    E-mail *:

    Registered company address *:

    City *:

    Region:

    Postal Code:

    Date business commenced *:

    Organisation type:

    If other, please provide your organisation type:

    BUSINESS AND CREDIT INFORMATION

    Primary business address *:

    City *:

    Region:

    Postal Code:

    How long at current address? *:

    Phone *:

    Fax:

    E-mail *:

    Bank name:

    Bank address:

    Phone:

    City:

    Region:

    Postal Code:

    Type of account:

    Account number:

    BUSINESS/TRADE REFERENCES

    Company name *:

    Address *:

    City *:

    Region:

    Postal Code:

    Phone *:

    Fax:

    E-mail *:

    Type of account:

    Company name *:

    Address *:

    City *:

    Region:

    Postal Code:

    Phone *:

    Fax:

    E-mail *:

    Type of account:

    Company name *:

    Address *:

    City *:

    Region:

    Postal Code:

    Phone *:

    Fax:

    E-mail *:

    Type of account:

    AGREEMENT

    1. All Final invoices are to be paid by 20th Month following & Disbursement Invoices to be paid 7 days from invoice date.

    2. Claims arising from invoices must be made within seven working days.

    3. By submitting this application, you authorize Jacanna Customs & Freight to make inquiries into the banking and business/trade references that you have supplied.

    Please tick this box to confirm that you have read and accept Jacanna Customs & Freight's Terms and Conditions in conjunction with the above points.

    SIGNATURES

    Title *:

    Name *:

    Date *:

    Title:

    Name:

    Date: