Section A: Company Details

Company Name: *

Trading name (if different from legal Incorporated name):

Company Registration #: *

Registered Address *

Telephone number: *

Email address for all Company notifications: *

Section B: Directors Details

Director 1 Details: *

Full Name
Residential Address
Drivers Licence #
Mobile Number

Director 2 Details:

Full Name
Residential Address
Drivers Licence #
Mobile Number

Section C: Buying Details

Authorised Buyer Details *

Full Name
Email
Mobile Number

Should the listed buyer leave your employment, please advise OneEnergy.nz immediately in writing so that the person’s buying authority may be removed.

Physical Address (where goods will be sent) *

Amount of Credit you require (maximum account balance at any one time): *

Section D: Trade References

Trade reference 1: *

Full name of company
Contact Person
Telephone number

Trade reference 2: *

Full name of company
Contact Person
Telephone number

I authorize any person or company to provide information of their experiences with me/us and authorize your provision of such information, without further permission, to others seeking similar validation.

Section E: Signatory

I / we will settle our account by the 20th of the month following invoice.

I / We agree to the credit terms here.

Director Name *

Director Signature *

Clear