Credit application and agreement

To set up a trading account with us, please complete the form below online or download a PDF version and post or email to us once complete.

Awanui Scientific credit application

"*" indicates required fields

Company / business name*

Trading name

Postal address*

Street Address Address Line 2 City ZIP / Postal Code

Nature of business*

Years established*

Years established under present ownership

Parent company*

Previous business name(s) if any

Business type*

(Please select option)

Name of Managing Director(s) / proprietors*

Name of your bank*

Bank branch*

Years with bank*

Contact name for invoices*

First Last

Position*

Email for invoices*

Phone number (for invoices)*

Would you prefer to receive statements by

(Please select option)

Contact details for statements*

(please select an option)

Contact name for statements*

First Last

Position*

Email for statements*

Phone number (for statements)*

Credit reference #1 – Contact name*

Credit reference #1 – Position*

Credit reference #1 – Company name*

Credit reference #1 – Phone number*

Credit reference #1 – Email address*

Credit reference #2 – Contact name*

Credit reference #2 – Position*

Credit reference #2- Company name*

Credit reference #2 – Phone number*

Credit reference #2 – Email address*

Your estimate of monthly credit required ($)*

All accounts are payable 20th of month following invoice date.

Consent*

I/we hereby acknowledge receipt of Awanui Scientific Ltd Terms and Conditions of Trade and upon acceptance by the supplier by way of written notice or the supply of goods and services and having read the Terms and Conditions of Trade agree to be bound accordingly. The customer further agrees to the obtaining and use of credit information supplied in this credit application.

Name of applicant*

First Last

Title

Company*

Date*

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