Company Details
NZBN / Business Number:
*
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Registered Name:
*
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Trading Name: *
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Company Type: *
Industry Type: *
No. of Directors: *
Registered Address Details
Address Search: *
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Trading Address Details

Postal Address Details

Further Information

Note: At least one contact number is required in each below sections. *
AUTHORISED SIGNATORY DETAILS SUBSECTION
First Name: *
Surname: *
Position:
Phone:
Mobile:
Email: *
Card Processing Details
Projected annual credit card volume ($): * 
Average transaction value ($): * 
Annual Refund %: * 
Annual Chargeback %: * 
Average order to delivery (days): * 
Do you offer Subscriptions? If so, advise if monthly, quarterly or annually: * 
Url - Website: * 
Beneficial Owners
*
A Beneficial Owner is a Non-Director with ownership of >25%.
Director Details
Title: *
First Name: *
Middle Name:
Surname: *
Date of Birth: * (dd/mm/yyyy)
*
Do you have a Driver Licence *
Do you have a Passport *
Current Address
Address Search *
Address not in list
Time at Address: Years  Months

Note: At least one contact number is required in below section. *
Contact Details
Phone Number:
Mobile Number:
Email Address: *

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Note: Bank Details are required in below section. *
Banking Details

Account NameAccount Number

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