Wholesale Application

Wholesaler Application

Join us as a wholesaler and get preferential pricing.

Date *

Registered Company Name *

Trading Name *

Address *

Postal Address+ *

Phone *

Mobile *

Email *

Accounts Contact *

Nature Of Business *

NZ Company Registration No. *

Date of Registration *

Directors/Partners/Proprietors Details

Name (1) *

Address (1) *

Phone (1) *

Date of Birth (1) *

Drivers License (1) *

Drivers License Upload (copy) *

Name (2) *

Address (2) *

Date of Birth (2) *

Drivers License (2) *

Drivers License Upload

Trade References

Trade Reference 1

Name *

Contact Person *

Phone *

Trade Reference 2

Name *

Contact Person *

Phone *

Guarantee

I/We the undersigned Company Director(s), /Partners(s)/Proprietor(s), their executors, administrators, transferees or successors, in acceptance of SmartSupply Pty Ltd granting credit and providing goods, HEREBY JOINTLY ANO SEVERALLY guarantee to Smart Supply Pty Ltd the payment of all debts. ANO IT IS AGREED that this guarantee is irrevocable and shall be a continuing guarantee. I/We further state that I/We are fully aware of the terms and conditions under which the account, if approved, is issued and guarantee that the account shall be operated in accordance with these terms and conditions.

Date *

Print Name *

Terms & Conditions

View the Terms & Conditions

Agree to Terms & Conditions *

Agree

Signature on behalf of the Applicant

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