Client Information Form

CLIENT INFORMATION FORM

Please complete all sections and read the Terms and Conditions of Trade.
This is a Client Information Form under the Construction Contracts Act 2002. Please read clause18 in our Terms of Trade
You can also download this form in PDF format to submit at a later time here

Full or Legal Name:

Physical Address

Post Code

Business Address

Post Code

Email Address

Phone No:

Fax No:

Mobile No:

Personal Details: (please complete if you are an individual)

Driver's License No:

D.O.B

Business Details: (please complete if you are a Sole Trader, Trust, Partnership, Company or Other - as specificied)

Trading Name:

Company Number

Date Incorp (current owners)

Contact Person

Phone No:

Nature of Business:

(1) Full Name:

D.O.B

Private Address

Postcode:

Driver's Licence No:

Phone Number

Mobile Number

(2) Full Name:

D.O.B

Private Address

Postcode:

Driver's Licence No:

Phone Number

Mobile Number

I certify that the above information is true and correct and that I accept the supply of credit DM Bobcats (if applicable). I have read and understand the TERMS AND CONDITIONS OF TRADE (overleaf or attached) of D M Bobcats 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. I agree that if I am a director/shareholder (owning at least 15% of the shares) of the Client I shall be personally liable for the performance of the Client’s obligations under this contract.

Name of Person Accepting this Form

Witness Name

Date

I agree to the terms and conditions

Ticking the acceptance box will act as my signiture