Credit Account Application

Country Selection
Country Selection*
Country of Business registration
The Applicant
The Applicant*
Please select entity type
Company Details
NZL company number*
ACN*
Registration Number*
NZBN
ABN
Legal Entity Name*
Does the applicant act as a trustee?
NZBN*
ABN*
VAT identification number
Trust Name*
Director Details
No of Directors*
Please enter a number from 1 to 5.
First Name
Other Name/s
Surname
Address
City
State
Postcode
Country
Phone
Email
Date of Birth
DD slash MM slash YYYY
Drivers licence
Director 2 Details
First Name
Other Name/s
Surname
Address
City
State
Postcode
Country
Phone
Email
Date of Birth
DD slash MM slash YYYY
Drivers licence
Director 3 Details
First Name
Other Name/s
Surname
Address
City
State
Postcode
Country
Phone
Email
Date of Birth
DD slash MM slash YYYY
Drivers licence
Director 4 Details
First Name
Other Name/s
Surname
Address
City
State
Postcode
Country
Phone
Email
Date of Birth
DD slash MM slash YYYY
Drivers licence
Director 5 Details
First Name
Other Name/s
Surname
Address
City
State
Postcode
Country
Phone
Email
Date of Birth
DD slash MM slash YYYY
Drivers licence
Trust Details
Trust ABN*
NZBN*
VAT Identification number
Trust Name*
Please select entity type of trustee*
Partnership Details
NZBN
Legal entity name
No of Partners*
Please enter a number from 1 to 5.
Partner details
First Name*
Other Names
Surname*
Date of Birth*
DD slash MM slash YYYY
Drivers licence*
Partner 2 Details
First Name*
Other Names
Surname*
Date of Birth*
DD slash MM slash YYYY
Drivers licence*
Partner 3 Details
First Name*
Other Names
Surname*
Date of Birth*
MM slash DD slash YYYY
Drivers licence*
Partner 4 Details
First Name*
Other Names
Surname*
Date of Birth*
MM slash DD slash YYYY
Drivers licence*
Partner 5 Details
First Name*
Other Names
Surname*
Date of Birth*
MM slash DD slash YYYY
Drivers licence*
Sole Trader Details
NZBN
ABN
VAT Identification number
Legal entity name
Please provide individual details
First Name*
Other Names
Surname*
Date of Birth*
MM slash DD slash YYYY
Drivers licence*
Contact Details
Trading name (if different)
Business Address
Street Address*
City*
Country*
Phone
Postal Address
Same as Business Address*
Street Address*
City*
State
Country*
Delivery Address
Same as Business Address2*
Street Address*
*
City*
State
Country*
Contact Person
Name*
Phone*
Email*
Accounts Contact
Same as main contact?*
Name*
Phone*
Email*
Invoice Email address*
Trading Details
Business Commenced
MM slash DD slash YYYY
Are the business premises owned, leased or mortgaged?
- Owned
- Leased
- Mortgaged
Type of Business
Estimated monthly purchases
Credit limit requested*
Trade References
Company name*
Contact person
Phone
Email
Company name*
Contact person
Phone
Email
Company name*
Contact person
Phone
Email
Terms and Conditions
Consent*
I/We acknowledge that we have read and accept the terms and conditions
All prices are subject to change without notice. All goods remain the property of ActiveVision until full payment has been received.

Manufacturer warranties apply to all components.

We will endeavor advise of any issues with stock levels, but cannot confirm stock availability until an order is confirmed.

Equipment prices are ex Store Auckland – all freight, insurance and GST are additional.

Specifications, brands are subject to change without notice.

Unless stated, installation and freight are not included and may be subject to additional costs.

Where installation is included in the quote, the price provided is an estimate and the final cost may be subject to change.

Please contact us for our full Terms and Conditions.
Terms of Trade
Accounts are due on the 20th of the month following invoice date, unless otherwise stated. Active Vision Limited reserves the rights to vary their credit terms or refuse supply if the specified terms of payments are not adhered to. We confirm acceptance of the specified terms of trading.
Email Address*

A copy of the completed form will be forwarded to the email address provided above.
Your name
Position in Company
Date
MM slash DD slash YYYY
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Credit Account Application

Country Selection

The Applicant

Company Details

Director Details

Director 2 Details

Director 3 Details

Director 4 Details

Director 5 Details

Trust Details

Partnership Details

Partner details

Partner 2 Details

Partner 3 Details

Partner 4 Details

Partner 5 Details

Sole Trader Details

Please provide individual details

Contact Details

Business Address

Postal Address

Delivery Address

Contact Person

Accounts Contact

Trading Details

Trade References

Terms and Conditions

Terms of Trade

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