New Customer Account Request
Account Details
Company / Trust / Org. / Govt. Department Name
*
Trading Name
*
Please verify that you are human
*
Postal Address
*
Street Address
Street Address Line 2
City
Suburb
Postal / Zip Code
Is Delivery address different from above address?
*
Yes
No
Note:
The Tip Top Ice Cream Company is unable to deliver to residential addresses.
Delivery Address
*
Street Address
Street Address Line 2
City
Suburb
Postal / Zip Code
Mobile Number
Phone Number
Email
*
example@example.com
Email for Invoice (if different from above)
example@example.com
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Business Description
Business Category
*
Cafe / Bakery / Takeaway / Parlours
Convenience / Dairy
Fruit & Vege
Event & Leisure
Mobile Vending
Petrol & Convenience
Recognized Trading Group
Others
Trading Group Name
Business Details
*
Business Type
*
Registered Company
Partnership / Sole Trader
Government
Trust / Incorporated Society
Identify Government Department
*
Contact Person
Non Mandatory Option
NZ Company Registration No.
*
Registered Address same as Postal Address?
*
Yes
No
Registered Office Address
*
Street Address
Street Address Line 2
City
Suburb
Postal / Zip Code
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Trustees 1
Trustees
*
First Name
Last Name
Residential Address
*
Street Address
Street Address Line 2
City
Suburb
Postal / Zip Code
Date of Birth
*
/
Day
/
Month
Year
Date Picker Icon
ID Proof Number - NZ Driver's License
*
NZ Driving License Version
*
Copy of NZ Driving License
*
Browse Files
Cancel
of
Trustees 2
Trustees
*
First Name
Last Name
Residential Address
*
Street Address
Street Address Line 2
City
Suburb
Postal / Zip Code
Date of Birth
*
/
Day
/
Month
Year
Date Picker Icon
ID Proof Number - NZ Driver's License
*
NZ Driving License Version
*
Copy of NZ Driving License
*
Browse Files
Cancel
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Director / Owner Details / Partner Name:
Director / Owner Name / Partner Name
*
First Name
Last Name
Residential Address same as Postal Address?
*
Yes
No
Residential Address
*
Street Address
Street Address Line 2
City
Suburb
Postal / Zip Code
Date of Birth
*
/
Day
/
Month
Year
Date Picker Icon
ID Proof Number - NZ Driver's License
*
NZ Driving License Version
*
Copy of NZ Driving License
*
Browse Files
Cancel
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Does the business have multiple Directors/Owners/Partners?
*
Yes
No
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Second Director / Owner Details / Partner Name:
Second Director / Owner Name / Partner Name
*
First Name
Last Name
Residential Address same as Postal Address?
*
Yes
No
Residential Address
*
Street Address
Street Address Line 2
City
Suburb
Postal / Zip Code
Date of Birth
*
/
Day
/
Month
Year
Date Picker Icon
ID Proof Number - NZ Driver's License
*
NZ Driving License Version
*
Copy of NZ Driving License
*
Browse Files
Cancel
of
Do you want to add a Third Directors/Owners/Partners?
*
Yes
No
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Third Director / Owner Details / Partner Name:
Third Director / Owner Name / Partner Name
*
First Name
Last Name
Residential Address same as Postal Address?
*
Yes
No
Residential Address
*
Street Address
Street Address Line 2
City
Suburb
Postal / Zip Code
Date of Birth
*
/
Day
/
Month
Year
Date Picker Icon
ID Proof Number - NZ Driver's License
*
NZ Driving License Version
*
Copy of NZ Driving License
*
Browse Files
Cancel
of
Do you want to add a Fourth Directors/Owners/Partners?
*
Yes
No
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Fourth Director / Owner Details / Partner Name:
Fourth Director / Owner Name / Partner Name
*
First Name
Last Name
Residential Address same as Postal Address?
*
Yes
No
Residential Address
*
Street Address
Street Address Line 2
City
Suburb
Postal / Zip Code
Date of Birth
*
/
Day
/
Month
Year
Date Picker Icon
ID Proof Number - NZ Driver's License
*
NZ Driving License Version
*
Copy of NZ Driving License
*
Browse Files
Cancel
of
Do you want to add a Fifth Directors/Owners/Partners?
*
Yes
No
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Fifth Director / Owner Details / Partner Name:
Fifth Director / Owner Name / Partner Name
*
First Name
Last Name
Residential Address same as Postal Address?
*
Yes
No
Residential Address
*
Street Address
Street Address Line 2
City
Suburb
Postal / Zip Code
Date of Birth
*
/
Day
/
Month
Year
Date Picker Icon
ID Proof Number - NZ Driver's License
*
NZ Driving License Version
*
Copy of NZ Driving License
*
Browse Files
Cancel
of
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Personal Guarantee
Please read and accept below conditions
Personal Guarantee
Do you agree with Personal Guarantee ?
*
Yes
No (subject to approval)
Reason for not agreeing with Personal Guarantee terms:
Privacy Act
Do you agree with Privacy Act ?
*
Yes
No (subject to approval)
Reason for not agreeing Privacy Act
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Payment Details
Payment Type
*
Direct Debit (Recommended Option)
Credit
Merchant
Type of Credit Account requested
*
7 Days
Site Code
*
If you wish to request a different payment terms, please provide details in the box below(subject to approval).
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Direct Debit
Does the account you are paying from require, in terms of your bank operating authority, one signature or multiple signatures
*
One Signature
Multiple Signatures
Authorization Code
Name on Bank Account (Acceptor)
*
My bank account number
*
Suffix number must be 3 digits.
Name of my bank
*
Example: ASB, ANZ, Westpac...
Signature
*
2nd Owner / Director
First Name
Last Name
Signature (2nd)
Bank Account No Proof
*
Browse Files
Please attach Company bank account detail (either bank deposit slip or printed bank statement detail), hand written numbers are not acceptable
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Change of Ownership
Is this a change of ownership (i.e. current Tip Top Account exists)?
*
Yes
No
Old Business Name
Old Customer Account No
Ownership Change Date
-
Day
-
Month
Year
Date
Is there a current TipTop freezer located on site?
*
Yes
No
Do you require a Freezer?
*
Yes
No
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Freezer Terms & Conditions
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Comments / Additional info
Note:
Submit
Should be Empty: