Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Postal Address *

Is postal address the same as delivery address?

Yes

No

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Type of Business *

Sole Trader

Limited Company

Individual

Club

Trust

Owner Name *

Business Owner

First Name

Last Name

Owner Mobile *

Business Owner

(###)

###

####

Manager Name *

Business Manager

First Name

Last Name

Manager Mobile *

Business Manager

(###)

###

####

Accounts Name *

Accounts Manager

First Name

Last Name

Accounts Mobile *

Accounts Manager

(###)

###

####

Name (Ref. 1) *

Credit Reference 1

First Name

Last Name

Phone (Ref. 1) *

Credit Reference 1

(###)

###

####

Name (Ref. 2) *

Credit Reference 2

First Name

Last Name

Phone (Ref. 2) *

Credit Reference 2

(###)

###

####

Name (Ref. 3) *

Credit Reference 3

First Name

Last Name

Phone (Ref. 3) *

Credit Reference 3

(###)

###

####

Companies to Open Trade Account *

Astrolabe Wines Limited

Beach House Wines Limited

Blackenbrook Wines Limited

Tutton Sienko and Hill (T/A The Boneline)

Doctors Flat Limited

Epicurious Limited (T/A Domaine Rewa)

A Thousand Years Limited (T/A Gladstone Vineyard)

Grasshopper Rock Wines Limited

No. 1 Family Estate Limited

Penkridge Trading Co Limited (T/A Penkridge Farm)

Tantalus Limited (T/A Tantalus Estate)

Village Vineyards Limited

X Wines Consulting Limited (T/A X Wines)

The Whanganui Distillery Co. (T/A Papaiti Gin)

Sandymount Kilns Distillery Limited (T/A Sandymount Distillery)

Geraldine Distillery Limited (T/A Humdinger Gin)

Brew Moon Brewing Company Limited

Bish Wines Limited (T/A Tony Bish Wines)

Credit Check *

Approval is given to the selected suppliers to contact credit references provided

Yes

Payment Terms *

Payment Terms are 20th of the month following the date of invoice for all suppliers

Yes

Ownership *

Goods remain the property of each supplier until all invoices are paid in full

Yes

Withholding Supply *

Wag & Co. Wine Distribution Ltd reserves the right to withhold supply of stock, on behalf of suppliers, if an account is outside trading terms

Yes

Interest Penalty *

If Payment Terms are not met a penalty interest rate may be imposed on any outstanding debts. A third party may be engaged to pursue any or all outstanding debts. Any expenses incurred in retrieving debts will be payable by the debtor.

Yes

Repossession *

If Payment Terms are not met, Wag & Co. Wine Distribution Limited are granted the right of entry to uplift stock, on behalf of all suppliers

Yes

Name *

Please provide us with the name of the person completing the application form

First Name

Last Name

Confirm 18+ *

Yes

Checkbox *

Please select all of the below checkboxes

I certify that the above information is true and correct and that I am authorised to make this application for credit.

I authorise the use of my personal information.

I have read and understand the terms and conditions of trade, which are intended to be read in conjunction with this Credit Account Application and agree to be bound by these conditions.

I agree that if I am a director or authorised person, I shall be personally liable for the performance of the companies obligations under this contract.

I agree to all terms and conditions of the credit application