Application Form

 

Please ensure you have the following information available prior to completing our Application Form: Trading Name, Establishment Date, Company Number, Ownership Structure, Banking Details, Accountants Details and Three Trade References. You must be the authorised company representative as will be deemed accountable for completing this application.

Please complete the form below so we can process your application (make sure you fill in all required (*) fields). We shall endeavour to respond within 3 working days (subject to ease of contacting trade references).

Name and Position of Applicant *
 
Application Date *
 
Phone Number *
 
Email Address *
 
Trading Name (e.g. Shop Name) *
Trading Name (e.g. Shop Name)
 
Company Name and Number *
Registered Legal Name and NZ Company Number
 
Postal Address *
Postal Address
 
Town/City *
 
Post Code/RD *
 
Delivery Address *
 
Town/City *
 
Bank Details *
Bank Name, Branch and Address
 
Bank Telephone Number *
Bank Telephone Number
 
Date Business Commenced *
Date Business Commenced
 
Accountancy Practice *
Accountancy Practice Name and Contact Person
 
Accountancy Phone Number *
Accountancy Phone Number
 
Do you own your own premises? *
 
Company Ownership Structure *
Company Ownership Structure
 
Limited Liability Status *
Limited Liability Status
 
Trade Reference 1 - Name, Contact and Phone Number *
Company Name, Contact Name and Phone Number of Trade Reference 1
 
Trade Reference 2 - Name, Contact and Phone Number *
Company Name, Contact Name and Phone Number of Trade Reference 2
 
Trade Reference 3 - Name, Contact and Phone Number
Company Name, Contact Name and Phone Number of Trade Reference 3
 
Bankruptcy *
Has any person named in this Application ever been declared bankrupt or been the director of a failed company?
 
If answered YES - please supply details.
 
Creditor Arrangement *
Has any person (or entity) named in the application ever been involved with a creditor pooling/repayment arrangement?
 
If answered YES - please supply details.
 
Guarantor Name and Contact Phone Number *
Please supply the name of a guarantor and phone number.
 
 

Declarations

PLEASE CLICK HERE to view and download our Agreement for the Supply of Goods on Credit, and our Terms and Conditions of Trade in order to complete the following declaration:

I/We (“the Applicant”) apply for a credit facility with Uni-Pak Limited (“Uni-Pak”), such credit facility to comprise this Agreement for the Supply of Goods on Credit (“the Agreement”) and our Terms and Conditions of Trade (“Conditions”). 1/We confirm we have viewed and downloaded the Agreement and Conditions, and agree to the following:

  1. The credit facility arrangements shall at all times be in accordance with the Agreement and the Conditions (which may from time to time be varied by notice to you).
  2. Credit may be withdrawn at any time without prior notice in accordance with the Conditions.
  3. I/we remain liable for payment of amount due under the Agreement and conditions in the event of any changes in respect of ownership of the Applicant until I/we have notified Uni-Pak and Uni-Pak has acknowledged in writing that I/we are no longer liable.
  4. Where the Applicant is a Limited Liability Company the undersigned guarantors (“the Guarantor”) jointly and severally request Uni-Pak to provide credit to the Applicant and in consideration of Uni-Pak agreeing to do so agree to guarantee the obligations of the Applicant to Uni-Pak in respect of such credit in accordance with the Agreement and the Conditions.
  5. The Applicant and the Guarantor (if any) irrevocably authorises any person to provide Uni-Pak with such information as Uni-Pak may require to determine whether to provide credit and as may be required to give effect to the Agreement and the Conditions and further irrevocably authorises Uni-Pak to provide to any third party details of the Applicant and the Guarantor (if any) and of any financial dealings that Uni-Pak may have with the Applicant and the Guarantor (if any).
  6. I/we the undersigned Applicant and Guarantor (if any) have read the Agreement and Conditions, and agree to abide by the Agreement and the Conditions and have received an email version of this completed Application for Credit.
  7. That I am authorised to act on behalf of the Applicant to complete this form and declare that the information given is true and correct to the best of my knowledge.
  8. That Uni-Pak reserves the right to decline this application, if accepted a signed copy of the Agreement for the Supply of Goods on Credit will be mailed to the Applicant.

Authorised Submission *
I am authorised by the Applicant to submit this form and I have read agreed to all Conditions.
 
 
 
Confirmation Code
This system prevents spamming, please enter this code in the box below
Confirmation Code
 
Enter Code *