Rockshop Quarry Products | Avondale, Pukekohe, Ardmore, Patetonga
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Client Application
0800 RKSHOP (757467)
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0800 RKSHOP
Menu
Products
Services
Cleanfill
Client Application
Visit Us
Client Application
Form
CREDIT APPLICATION AND CLEANFILL DECLARATION BY:
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Business Name
*
Nature of Business
*
Select any one
Limited Company
Partnership
Sole Trade
Other
Period trading under present owners
*
Layout
Business started year
*
Trading as
*
Address of Buiness
Postal Address
*
Email
*
Fax
Town
*
Telephone
*
Phone
*
Residential Phone
*
Name and Address of Directors, Partners, Sole Trader
First Candidate Details
Name (First)
*
Name (Second)
*
Name (Third)
*
Address (First)
*
Address (Second)
*
Address (Third)
*
Telephone (First)
Telephone (Second)
Telephone (Third)
Date of Birth (First)
*
Date of Birth (Second)
*
Date of Birth (Third)
*
Layout
ID Type (Partners/Sole Trader)
*
Bank/Branch
*
Account No
*
Trade Credit References, minimum of three required.
Must be firms with whom you are dealing with on the same level of credit as you are applying for
Trade Credit References
Name (First)
*
Name (Second)
*
Name (Third)
*
Address (First)
*
Address (Second)
*
Address (Third)
*
Telephone (First)
*
Telephone (Second)
*
Telephone (Third)
*
Is Order number required?
*
Yes
No
Layout
Contact Name for Account Queries
*
Telephone
Maximum credit required $
*
Submit
