Customer application

The type of application

I am applying as a:

Company Sole Trader or Individual Other (please specify on the next step)

* Is intended for Company: Trade or Limited Liability Company or Partnership

Organisation Legal Name

Organisation Type

Trading Name (if applicable)

GST Number (if applicable)

Organisation Number

NZBN

Business Phone Number

Mobile Phone Number

Company Address

Contact(s) for: invoices; statements; queries

Full Name

Position/Contact purpose

Phone

1. Directors/Partners/Proprietors/Shareholders(s)

Full Name

Designation

Residential Address

Phone

Date of birth

2. Directors/Partners/Proprietors/Shareholders(s)

Full Name

Designation

Residential Address

Phone

Date of birth

Full Name

Residential Address

Phone

Mobile

Date of birth

Trading Name (if applicable)

GST Number (if applicable)

Goods to be supplied

Goods list

and any other goods and associated services supplied by Highland Agri Solutions Limited (referred to in this form as us/we/our) to the customer named above from time to time (Goods).

Minimum of two regular established accounts

Reference 1

Reference 2

Reference 3

Reference 4

In consideration of us agreeing to supply Goods (and any associated services) to the Customer named above, then, on behalf of the Customer, you:

Agree to the Terms of Trade linked here.

Declare that the information supplied in this form is correct.

Do you want to receive marketing communications from us? We won’t spam you. See our Privacy Policy.

Whether you’re opening a new account or applying for trade credit, we’ve made it straightforward. Tell us a bit about your operation and our team will be in touch with next steps—so you can keep focusing on the farm, across Otago and Southland.

The type of application

Contact(s) for: invoices; statements; queries

1. Directors/Partners/Proprietors/Shareholders(s)

2. Directors/Partners/Proprietors/Shareholders(s)

Goods to be supplied

Minimum of two regular established accounts

Get in touch

Customer application

Whether you’re opening a new account or applying for trade credit, we’ve made it straightforward. Tell us a bit about your operation and our team will be in touch with next steps—so you can keep focusing on the farm, across Otago and Southland.

The type of application

Contact(s) for: invoices; statements; queries

1. Directors/Partners/Proprietors/Shareholders(s)

2. Directors/Partners/Proprietors/Shareholders(s)

Goods to be supplied

Minimum of two regular established accounts

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