ACCOUNT

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CUSTOMER DETAILS

Billing Address

OWNERSHIP DETAILS

IF LIMITED LIABILITY COMPANY

TRADE REFERENCES

REFERENCE 1
REFERENCE 2

I/We are make to payment in 20 th of the following month of invoice, either by direct credit to: 01-0221-05250890525089-00 or cheque.

PRIVACY ACT : from time to time, DAON NZ Limited may collect and use information it collects and holds for purposes relating to the application for credit. Provision of credit, credit assessment and debt recovery (including collecting information from, and disclosing information to, credit reporting agencies, debt collection agencies, trade references and other third parties), to register any security interest and to provide you with marketing materials. Under the Privacy Act, individuals have rights of access to, and correction of, their personal information. Personal information collected by DAON NZ Limited will be held at 8 Titoki Place, Albany, Auckland 0632. To request access to your personal information email info@daon.co.nz. If debt collection is required at any time, all debt collection cost will be added to the debt for collection.

Authorisation : The Customer and each of the individuals named s a e below hi s DAON NZ L imited to collect and use information fromany person or entity for any of the above purposes, and such person or entity to disclose information to DAON NZ L imited, and also authoriauthorises DAON NZ Limited to disclose information to any person or entity for any of the above purposes and such person or entientity to collect and use information from Limited.

The Customer and each of the individuals named below confirms that the information it has provided to DAON NZ Limited as true and correct.

To be signed by the Customer named above. For a company, to be signed by at least two directors, or if there is only one director, that director and a witness. Otherwise, to be signed by the sole trader, each partner, each trustee, or any authorised signatory of an other entity and a witness(es).

SIGNATURE OF THE CUSTOMER

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