Credit Application Form CUSTOMER’S FULL LEGAL NAME (i.e. not trading name): TYPE OF BUSINESS: Sole TraderIndividualPartnershipLtd CompanyOther Trading Name (if different from legal name): Postal Address: Delivery Address: Email Address: Account Contact: Business Phone: Home Phone: Fax Number: Mobile: Dairy Number: GST Number: Please if you are an Individual/Sole Trader/Partnership or LIMITED LIABILITY COMPANY Individual/Sole Trader/PartnershipLIMITED LIABILITY COMPANY Fill in full name and DOB (please provide photo ID – NZ drivers licence, NZ passport or NZ firearms licence): Full Name: Date of Birth Add New Upload ID Drag & Drop Files Here or Browse Files Fill in full name of Directors and DOB (please provide photo ID – NZ drivers licence, NZ passport or NZ firearms licence): Full Name: Date of Birth Add New Upload ID Drag & Drop Files Here or Browse Files CREDIT/TRADE REFERENCES 3 required (excluding credit cards, fuel suppliers, landlord, power and phone) Name: Contact Name: Phone Number: Name: Contact Name: Phone Number: Name: Contact Name: Phone Number: Add New DECLARATION: We have read, understood and agree to be bound by the Terms of Trade, as attached, and understand and accept that this form and the Terms of Trade will govern every order or confirmation of quotation we enter into with the Company for the purchase of goods and/or services. We agree that the MacDougall’s Agri Services Limited Order Form will also apply to any accepted order made on such form and that if specified on the Order Form then I/We agree that the goods will be installed and/or services provided by the Company for the price specified on the Order Form. We confirm that all information supplied is accurate and may be held and disclosed to any other person (including credit reference agencies and debt collection agencies) for the purposes for which it is supplied (that is, for checking and/or assessing my/our creditworthiness and/or collecting any debt owed by me/us) and hereby authorise any person to provide you with information to satisfy your credit enquiries or the collection of monies owing to you. We agree that the Terms of Trade provide for Retention of Title and grants to the Company a Security Interest in my/our personal property which is supplied by the Company, to secure the payment to the Company of all monies I/we may owe the Company from time to time and at any time. We warrant that I/we are authorised (where applicable) to enter into this contract on behalf of the Customer. I/we unconditionally guarantee to pay on demand all amounts owing by the Customer in consideration of the Company supplying the Goods and Services to the Applicant and in doing so acknowledge the warning to guarantors and clause 7 of the Terms of Trade.