Trade Account Application Form

Trade Account Application

Full Legal Name of Reseller

Trading Name (if different):

Entity Type

Posting/Billing Address

Posting/Billing Address Postcode

Physical Address & City

Physical Address Postcode

Primary Contact Person:

Position:

Phone:

Email:

Mobile:

Direct Dial:

Business Billing Contact Name:

Business Billing Email:

Details of Persons able to make financial decisions on behalf of the business.

Manager/Owner/ Director/Partner:

Full Name:

Home Address

Postcode

Manager/Owner/ Director/Partner: 2

Full Name:

Home Address

Postcode

Trade References (please do not include power, telecommunications or utility companies):

Reference 1

Business Name:

Account Number:

Contact Person:

Phone:

Email:

Reference 2

Business Name:

Account Number:

Contact Person:

Phone:

Email:

Acknowledgements - Click here to see Reseller Agreement

I certify that the information in this credit application form is true and correct and that I am authorised to accept these credit application terms.

I acknowledge and accept that the Reseller Terms which are part of this form (as may be amended by Reterniti Holdings Limited from time to time, in accordance with the Reseller Terms) will apply to all orders for Reterniti Stones placed the Reseller.

I irrevocably authorise Reterniti Holdings Limited to check the Reseller’s credit status with any credit reporting agency for the purposes of assessing whether to approve this credit application. I agree that Reterniti Holdings Limited may pass on credit information about the Reseller (including failure to make payments to Reterniti Holdings Limited) to any credit reporting agency. I understand the credit reporting agency may give that information to its customers if they seek credit information about the Reseller.

The form was sent successfully.

An error occured.

Title of the document