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
*Please note that 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
Back
Next
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
*
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
Back
Next
Director / Owner Details
Director / Owner 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
*
NZ Driving License
NZ Passport
International Passport
ID Proof Number
*
NZ Driving License Version
Next of Kin Name
*
First Name
Last Name
Relationship
*
Next of Kin address same as Requester Postal Address?
*
Yes
No
Private Address
*
Street Address
Street Address Line 2
City
Suburb
Postal / Zip Code
Phone / Mobile Number
*
Back
Next
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
Back
Next
Payment Details
Payment Type
*
Credit
Direct Debit
Merchant
Type of Credit Account requested
*
7 Days
20th of the month following
Site Code
*
Back
Next
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
*
Name of my bank
*
Example: ASB, ANZ, Westpac...
Signature
*
Clear
2nd Owner / Director
First Name
Last Name
Signature (2nd)
Clear
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
Cancel
of
Back
Next
Change of Ownership
Is business changing ownership?
*
Yes
No
Old Business Name
Old Customer Account No
Ownership Change Date
-
Day
-
Month
Year
Date
Are you taking responsibility of current Freezer?
*
Yes
No (Tip Top will remove current freezer)
Do you require a Freezer?
*
Yes
No
Back
Next
Freezer Terms & Conditions
Back
Next
Comments / Additional info
Note:
Submit
Should be Empty: