Credit Account Application

Before filling in this Credit Application form please observe these requirements before we can process it. These requirements are put into place as part of our Quality Assurance System.

(a) Your company requires a trading history with EMPR New Zealand, either paid by Credit Card or Direct Deposit.

(b) Trade References need to be Credit type, Not C.O.D. or other forms of Pre-Payment.

I / We the undersigned hereby make application for credit and provide the information contained herein which is warranted to be true and correct, for the purpose of establishing a credit account with EMPR New Zealand.


Fields marked *are required.

Credit Application Type

Company Information

Director Information

Director [1]

Last Three Trade Reference

Trade Reference [1]
Trade Reference [2]
Trade Reference [3]

Anticipated Monthly Expenditure

$

Accounts Payable Details

Your Details

I / We agree to pay all accounts within the timeframe advised if credit is approved.

I / We also agree to pay any and all legal costs or collection fees and commissions which may be incurred in recovery of any part of this account when it is not paid within the terms of days as stated above.

I / We understand that the credit facility, if extended, maybe withdrawn at the discretion of the EMPR and that I / We shall be notified of such withdrawal.

Company Information

Account Information

Purchase Order Sequence Information

EMPR use Purchase Order Sequence information to automatically verify your orders. If your order does not match your purchase order sequence EMPR may contact you to verify your order. This is used to reduce the risk of fraudulent activity.

Example:

Purchase Order Number: BC20000068

Number Digits: 10

Starting Number/Letter: B

By submitting this form you are confirming that you have read and understood the Terms & Conditions of EMPR® Australia.