Account application form

Please complete the details below to apply for an account. If you would prefer to print out the form you can download the form here, scan it, and email the completed form to info@henwood.co.nz.

Entity Details

Applicants Full Legal Name(Required)

First Last

Business type(Required)

Trading as(Required)

Postal Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Physical Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email(Required)

Nature of business(Required)

Years in business(Required)

Phone(Required)

Fax

Date of Birth

Contact Name(Required)

First Last

Contact Position(Required)

Ownership

Please insert Owner(s) / Directors Name(s) in full

1. Name(Required)

First Last

1. Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

2. Name

First Last

2. Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

IF LIMITED LIABILITY COMPANY – Address of Registered Office

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Date of Incorporation

Incorporation No

Financial & professional advisors

Shareholders Funds

Paid Up

Name of Accountant

Solicitor

Bank

Branch

Acct No

Trade references

1. Company

1. Contact Name

First Last

1. Phone Number

1. Account open since

2. Company

2. Contact Name

First Last

2. Phone Number

2. Account open since

General Description of Goods and services/Goods and services/Services to be provided

Signature(Required)

HENWOOD ELECTRICAL LTD

23D Hewlett Street Whangarei

Ph 24/7 (09) 4381227

Fax (09) 4389317

Email: info@henwood.co.nz