If you should experience any difficulties completing this form, please contact + 64 4 495 0700 Interface (Web) [FUJITSUNZ]
Company Details
Enter the details of the applying company. An asterisk symbol (*) denotes a required field.

If you are having difficulty filling out this web form, please download a copy of the required form below;

Business Type: *
NZBN:
 
Registered Name:
*
Main Business Activity: *
Main Contact: *
Title / Position: *
GST Number * 
Purchase Order Required? * 

Finance Details
Credit Amount Required: *

Contact Details
Accounts Contact Email Address: *
Invoice Email Address:
(We prefer a Generic Department email address e.g. accounts@abcxyz.co.nz)
Tel No:
() *

Trading Address
Property:
Unit Number:
Street Number: *
Street Name: *
Street Type: *
Suburb:
City: *
Postcode: *   

Billing Address

Shipping Address

Trade References (Name, Address & Phone number please
Trade Reference 1
Name: *  
Address: *  
Phone Number: () *  

Trade Reference 2
Name: *  
Address: *  
Phone Number: () *  

Trade Reference 3
Name:  
Address:  
Phone Number: ()  

Contact person for Personal Property Securities Register
Name: *  
Position: *  
Tel No: () *  
Contact Address:
(if different from postal address)  
Email Address: *  

Fujitsu Sales Representative
Sales Rep Name: *
E-mail Address: *

Payment Terms
*

Collection of Information

I understand that all personal information collected by Fujitsu concerning me (including the information collected in this form) is collected and may be stored, used or disclosed in order to determine whether or not Fujitsu will provide or continue to provide credit to the organisation on whose account I am making this application for, and enforce any obligations that organisation may have to Fujitsu in respect of that credit. The personal information will be held by Fujitsu at the address shown above. I understand that I have the right obtain access to and request correction of the personal information provided in accordance with the Privacy Act 1993.

I authorise Fujitsu to obtain any personal information concerning me that Fujitsu considers is necessary for the above purposes from any person or organisation. I authorise any person from whom Fujitsu requests personal information concerning me to release that information to Fujitsu. I also authorise Fujitsu to release my personal information for communicating promotional activities and product information and for debt collection purposes.
I understand that all personal information collected by Fujitsu concerning me (including the information collected in this form) is collected and may be stored, used or disclosed in order to determine whether or not Fujitsu will provide or continue to provide credit to me or my organisation, and enforce any obligations I or my organisation may have to Fujitsu in respect of that credit, including but not limited to registering a Financing Statement in accordance with Fujitsu’s rights under the Personal Properties Securities Act 1999. The personal information will be held by Fujitsu at the address shown above. I understand that I have the right as a sole trader, partnership, trustee or as a director of a company to obtain access to and request correction of the information provided in accordance with the Privacy Act 1993.

I authorise Fujitsu to obtain any personal information concerning me that Fujitsu considers is necessary for the above purposes from any person or organisation. I authorise any person from whom Fujitsu requests personal information concerning me to release that information to Fujitsu. I also authorise Fujitsu to release my personal information to any person for the purposes of determining credit worthiness, for communicating promotional activities and product information and for debt collection purposes.

*

Partners or Directors (Where applicable)
Enter the details of the relevant Directors, Proprietors, Partners or Trustees as appropriate. An asterisk symbol (*) denotes a required field.