Wholesale Account Application - Good Clean Health Co (GCHC Limited)

Account Application

Business Name

Trading Name*

Type of Business

Limited Company

Parternship

Sole Trader

Other

GST Number if applicable

Registered Business Number (NZBN)

Physical Address

Please let us know why our products would be suitable for your business?

How did you find out about us?

ACCOUNTS DEPARTMENT

Email Address for accounts

Contact name for account queries

Phone Number for accounts

Please confirm your estimated annual spend

< $5k

> $5k

AUTHORISATION

I confirm that I am a duly authorised officer of the above-mentioned company and the information supplied on this form is true and accurate to the best of my knowledge.

I acknowledge that as we engage GCHC Ltd for services, we agree to the terms and conditions as set out by GCHC Ltd.

Terms and Conditions are available on request or are on the bottom of our website.

GCHC Ltd Loft 3, 36-38 Southwark Street, Christchurch 8011
hello@goodcleanhealthco.com | 03 595 6552

Full Name

Position Held

Date