Credit Application

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Please fill in the form below to apply for a new customer account with Weighing & Measuring Solutions (New Zealand) Ltd.

Name of company/partnership/sole trader*
Is the Trading name the same as the name above?
- Yes
- No
Trading name*
Accounts Payable Contact Name*
Accounts Payable Email*
Accounts Payable Phone*
Street Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Postal Address
Same as street address?

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone Number*
Fax Number
Registered address of company*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
NZBN #
Date of incorporation
MM slash DD slash YYYY
Nature of business*
Number of Years in the Business*
If new, please state*
- Yes
- No
Please give previous employment or business
Full names and addresses of directors of current company*
Surname Christian Name Private Address Private Phone
Name of accountant*
Address of accountant*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Name of solicitor*
Address of solicitor*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Name of Bank*
Bank Branch*
Trade Credit References*
Name Address of Branch Phone Number

Nominate only business dealing with you on credit terms. If none, please give any personal dealings made on credit terms
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Surname	Christian Name	Private Address	Private Phone

Name	Address of Branch	Phone Number