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*Required fields

Basic Details

Type*

Individual

Sole Trader

Trust

Partnership

Company

Other

First Name*

You must enter your first name.

Last Name*

You must enter your last name.

D.O.B.*

You must enter your D.O.B.

Driver's Licence No

Contact Phone Number*

You must enter your phone number.

Fax No

Mobile No*

You must enter your mobile number.

Contact Email*

You must enter your email address.

Repeat Email*

You must re-enter your email address.

Account Password*

You must enter your password.

Repeat Password*

You must re-enter your password.

Passwords must be at least 8 characters long, contain upper & lower case letters and numbers

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*Required fields

Physical Address

Same as the billing address

Street Number/Unit*

You must enter your street number.

Street Name*

You must enter your street name.

Suburb*

City/Town*

You must enter your city.

Post Code*

You must enter your post code.

Country*

Billing Address

Street Number/Unit*

You must enter your street number.

Street Name*

You must enter your street name.

Suburb*

City/Town*

You must enter your city.

Post Code*

You must enter your post code.

Country*

Billing Email*

You must enter your billing email address.

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No need to fill in business details. Please go to the next page.

*Required fields

Business Details

I have a GST No

Company Name*

You must enter your company name.

GST No*

You must enter your GST No.

I have a NZBN

NZBN*

You must enter your NZBN.

Date Incorp*

You must enter your Date Incorp.

Contact Person*

You must enter your contact person.

Phone No*

You must enter your phone no.

Nature of Business*

You must enter your business nature.

Directors / Owners / Trustee

Full Name*

The field is required.

D.O.B.*

The field is required.

Residential Address*

The field is required.

Postcode*

The field is required.

Driver's Licence No*

Phone No*

The field is required.

Mobile No*

The field is required.

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*Required fields

Privacy Officer Details

I have a privacy officer

Privacy officer's full name*

The field is required.

Privacy officer's phone no*

The field is required.

Privacy officer's email*

The field is required.

I certify that the above information is true and correct and that I accept the supply of credit by Ben Knows Limited. I have read and understand the TERMS AND CONDITIONS OF TRADE of Ben Knows Limited which form part of, and are intended to be read in conjunction with this Client Information Form and agree to be bound by these conditions. I authorise the use of my personal information as detailed in the Privacy Act clause therein.

Signature*

Name*

The field is required.

Position*

The field is required.

I have read and I accept the Terms and Conditions (click to view)

You must agree before submitting.

Services

Basic Details

Physical Address

Billing Address

Business Details

Directors / Owners / Trustee

Privacy Officer Details