Account Application

Applicant's Full Legal Name (i.e. not trading name) *

Business Type *

Ltd Company

Individual

Sole Trader

Partnership

Other

Other Business Type (if selected above)

Trading as

Postal Address *

Post Code *

Contact Information

Telephone *

Fax

Mobile

Email *

Business Details

Nature of Business *

Years in Business *

Contact Name & Position *

Expected Annual Usage (in litres) *

Which Gull site/sites will you predominantly use? *

If a Limited Liability Company

Address of Registered Office

Date of Incorporation

New Zealand Business Number

Account Holders Contact Details (if different from above)

1) Name

Email

Phone

2) Name

Email

Phone

Trade Reference (Must be provided) *

1) Company *

Contact Name *

Phone No *

Account Open Since *

Certification

I hereby certify that the above information is to the best of my knowledge and belief, true and correct; and that I am duly authorised to make this credit account application on behalf of the applicant. *

Print Name *

Position *

Date *