Customer Application Form

CUSTOMER APPLICATION FORM

 

CUSTOMER:                                   Trade                        Private

 

Limited Liability Company

Partnership

Sole Trader

Other …………………………………………………..

 

Legal Name:

 

 

 

Company Number if a company / Date of Birth if an individual: ………………………………………………………………………………..

 

Postal Address:

…………………………………………………………………………………………………………………...................

 

Email:

…………………………….

Telephone:

………………………….......

Fax:

……………………………..

 

Contact Person:

………………………………………………………………………………………………………………………………

 

Name and Address of Directors / Partners / Proprietors / Shareholders

 

Name:

 

Designation:

 

Residential Address and Telephone Number:

 

Date of Birth:

 

………………................

 

…………………............

 

………………………………………………………….

 

………………….

 

 

 

 

GOODS TO BE SUPPLIED: 

 ………………………………………………………………………………………………………………………………………………………..

 ……………………………………………………………………and any other goods (and any associated services) supplied by I. C. Clear Limited trading as Matamata Saddlery (referred to in this form as "us"/"we"/"our") to the customer named above from time to time ("Goods")

 

CREDIT REFERENCES:  Name, address and telephone numbers (minimum of 2 regular established accounts)

1. ………………………………………………………………………………………………………………………………………………………..

2. ………………………………………………………………………………………………………………………………………………………..

 

DECLARATION AND AGREEMENT:

In consideration of us agreeing to supply Goods (and any associated services) to the Customer named above, you (or in the case of a Customer  that is not a private individual, on behalf of the Customer, you):

1.  Agree to the Terms of Trade set out on the reverse side of this form; and

2.  Declare that the information supplied in this form is correct.

Full Name: …………………………………………………………….

 

Signed:………………………………………… ……..………………………….

Designation: ……………..……………………………………………

 

Date:…………………………………………… ………………..……………….

 

GUARANTEE:

In consideration of I. C. Clear Limited trading as Matamata Saddlery agreeing to supply Goods (and any associated services) to the Customer at my/our request: 

1.  I/We unconditionally guarantee to I. C. Clear Limited trading as Matamata Saddlery the due and punctual payment by the Customer of all moneys payable in accordance with the Terms of Trade set out on the reverse side of this form as and when the same become due and payable by the Customer.

2.  I/We agree to be deemed as principal debtor for all accounts held by the Customer with I. C. Clear Limited trading as Matamata Saddlery.

3.  I/We agree that this guarantee shall be a continuing guarantee and shall not be discharged by any settlement or payment of account and that this guarantee is both joint and several.

4.  I/We agree that our liability under this guarantee shall not be discharged, abrogated, prejudiced or affected by:

     a.  the granting of time, credit or the indulgence or other concession to the Customer;

     b.  any alteration, modification, variation or addition to any agreement in respect of the supply of goods and services; or

     c.  any other act, omission or event which but for this provision might operate to discharge, impair or otherwise affect, my/our obligations under this guarantee or any powers or remedies conferred upon I. C. Clear Limited trading as Matamata Saddlery by this guarantee or by law.

5   I/We confirm that I/we have been advised by I. C. Clear Limited trading as Matamata Saddlery that I/we should seek legal advice before signing this guarantee.

 

Name: ……….…………………………………......

Signed: ……………………………………………..

Designation: ……………………………………….

Witness Name: ……………………………………

Witness Signed: ……………………..…………...

Date: ………………………………………………

Name: ………………………………………………

Signed: ……………………………………………..

Designation: ……………………………………….

Witness Name: ……………………………………

Witness Signed: ………………………………….

Date: ………………………………………………

                                         

 

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