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New Account Application Form

For applying to trade with WELEDA on a commercial credit basis

Please read and accept the Terms and Conditions prior to submitting this form.

To qualify for a wholesale account you need to be GST registered, sell or use our products in your store/practice and keep the account active.

New Account Application Terms and Conditions

Apply below

Registered Company Name *

Company Number *

Trading Name *

GST Number *

Year Business Commenced *

Name of Owner/Manager *

Type of Business *

Business Trading Address – Line 1 *

Business Trading Address – Line 2

Business Trading Address – Line 3

Delivery Suburb *

Delivery Town/City *

Delivery Postcode *

Phone Number

Mobile Number *

Accounts Email *

Communications Email *

Mailing Address – Line 1 *

Mailing Address – Line 2

Mailing Address – Line 3

Mailing Suburb *

Mailing Town/City *

Mailing Postcode *

Credit Amount Required per Month *

Name of Authorised Person completing this form *

Title of Authorised Person completing this form - must be Director, Owner or Managing Director *

Phone Number of Authorised Person completing this form *

Date *

Tick to agree to Terms & Conditions *

Credit Card details are required for PrePaid Monthly Credit

Credit Card Number

Name on card

Expiry Date

Credit References are required for $1,000 Monthly Credit

Reference 1:

Company Name

Address

Phone Number

Reference 2:

Company Name

Address

Phone Number

Reference 3:

Company Name

Address

Phone Number

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Weleda NZ

New Account Application Form

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New Account Application Form

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