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Trade Application Form

Trade & Wholesale

Step 1 of 6

About You

Customer Name / Trading Name(Required)

Name

Business Structure:(Required)

Trade References (Excluding credit cards, fuel suppliers, power and phone suppliers)

Business Name, Contact Name & Email

Business Name

Contact Person

Business Name

Contact Person

Business Name

Contact Person

All Applicants to complete this section:

Company Name(Required)

Trading Name (if different from Company name)

Previous Trading Name

Number of years trading(Required)

Please enter a number from 1 to 100.

Postal Address(Required)

Street Address Address Line 2 City ZIP / Postal Code Country

Is your Postal Address the same as your Physical Address?(Required)

Yes

Physical Address

Street Address Address Line 2 City ZIP / Postal Code Country

Phone: Business

Phone: Mobile(Required)

Email for Accounts(Required)

Email for Tradelists

GST Number

Type of Business (Industry)

Bank

Branch

Limited Company Details

Company Number

Contact Person for Accounts

Certification of Incorporation (Please upload)

Drop files here or

Max. file size: 128 MB.

Please upload

Directors' Details

Name

First Last

Phone

Date of Birth

Address

Street Address Address Line 2 City ZIP / Postal Code Country

Add another Director?

Yes

Name

First Last

Phone

Date of Birth

Address

Street Address Address Line 2 City ZIP / Postal Code Country

Add another Director?

Yes

Name

First Last

Phone

Date of Birth

Address

Street Address Address Line 2 City ZIP / Postal Code Country

Add another Director?

Yes

Name

First Last

Name

First Last

Phone

Date of Birth

Address

Street Address Address Line 2 City ZIP / Postal Code Country

Shareholders' Details

Name

First Last

Phone

Date of Bith

Address

Street Address Address Line 2 City ZIP / Postal Code Country

Add another Shareholder

Yes

Name

First Last

Phone

Date of Bith

Address

Street Address Address Line 2 City ZIP / Postal Code Country

Add another Shareholder

Yes

Name

First Last

Phone

Date of Birth

Address

Street Address Address Line 2 City ZIP / Postal Code Country

Add another Shareholder

Yes

Name

First Last

Phone

Date of Birth

Address

Street Address Address Line 2 City ZIP / Postal Code Country

Sole Trader / Partnership Details

Phone

Date of Birth

Number of Shares

Please enter a number from 1 to 100.

Address

Street Address Address Line 2 City ZIP / Postal Code Country

Add Another Partnership

Yes

Name

First Last

Phone

Date of Birth

Number of Shares

Please enter a number from 1 to 100.

Address

Street Address Address Line 2 City ZIP / Postal Code Country

Add Another Partnership

Yes

Name

First Last

Phone

Date of Birth

Number of Shares

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Add another Partnership

Yes

Name

First Last

Phone

Date

Number of Share

Address

Street Address Address Line 2 City ZIP / Postal Code Country

Identification Type & Number

(Upload copies)

Birth certificate/Driver’s licence/Passport Number:

File

Max. file size: 128 MB.

Birth certificate/Driver’s licence/Passport Number:

File

Max. file size: 128 MB.

Birth certificate/Driver’s licence/Passport Number:

File

Max. file size: 128 MB.

Birth certificate/Driver’s licence/Passport Number:

File

Max. file size: 128 MB.

Next of Kin not living with you (for Sole Traders, Partnerships only)

Name

First Last

Phone

Address

Street Address Address Line 2 City ZIP / Postal Code Country

Occupation

Relationship to you

By signing this application all parties agree to credit checks against both the company and any parties signing the form

PERSONAL GUARANTEE IF APPLICANT IS A COMPANY

1. 2. 3. In consideration of Kiwiflora Nurseries entering into this agreement to supply the Customer, at the request of the guarantor, the guarantor hereby unconditionally and irrevocably guarantees the due and punctual performance, observance and compliance by the Customer will all of the provisions of this agreement. Although as between the Guarantor and the Customer, the Guarantor may be a surety only, as between the Guarantor and Kiwiflora Nurseries, the Guarantor shall be liable as a principal party under this guarantee or under any extension, amendment or variation of this guarantee and may be so treated in all respects by Kiwiflora Nurseries. The liquidation of bankruptcy of the Customer or the Guarantor or any of them or any person or persons or the exercise or non-exercise by Kiwiflora Nurseries of any of the powers of Kiwiflora Nurseries under this guarantee or the waiver or partial waiver, variation, modification, assignment or transfer of this agreement, or any other dealings whatsoever by Kiwiflora Nurseries with the Customer or Guarantor or any other person or persons shall not exonerate or release the Guarantor from liability under this guarantee nor shall the Guarantor be released by any other act, omission or thing whatsoever whereby the Guarantor as surety only would have been so released.

GUARANTOR’S EXECUTION (all companies to complete)

I HEREBY ACKNOWLEDGE AND AGREE TO THE ATTACHED TERMS AND CONDITIONS OF SALE AND THE TERMS OF THE GUARANTEE CONTAINED ABOVE

Signature

Witness Signature

Name

First Last

Witness Name

First Last

Relationship to Applicant

Occupation

Address

Street Address Address Line 2 City ZIP / Postal Code Country

Address

Street Address Address Line 2 City ZIP / Postal Code Country

Date

Gift Vouchers
Available

Trade Application Form

Trade & Wholesale

About You

Trade References (Excluding credit cards, fuel suppliers, power and phone suppliers)

All Applicants to complete this section:

Limited Company Details

Directors' Details

Shareholders' Details

Sole Trader / Partnership Details

Identification Type & Number

Next of Kin not living with you (for Sole Traders, Partnerships only)

Trusts / Incorporated Societies

For Incorporated Societies

By signing this application all parties agree to credit checks against both the company and any parties signing the form

PERSONAL GUARANTEE IF APPLICANT IS A COMPANY

GUARANTOR’S EXECUTION (all companies to complete)

Shop Plants

Gift Vouchers Available

Trade Application Form

Trade & Wholesale

About You

Trade References (Excluding credit cards, fuel suppliers, power and phone suppliers)

All Applicants to complete this section:

Limited Company Details

Directors' Details

Shareholders' Details

Sole Trader / Partnership Details

Identification Type & Number

Next of Kin not living with you (for Sole Traders, Partnerships only)

Trusts / Incorporated Societies

For Incorporated Societies

By signing this application all parties agree to credit checks against both the company and any parties signing the form

PERSONAL GUARANTEE IF APPLICANT IS A COMPANY

GUARANTOR’S EXECUTION (all companies to complete)

Shop Plants

Gift Vouchers
Available