Wholesale Application

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This is the application form for wholesale customers.

PLEASE NOTE: All fields are required to complete this form.

Wholesale Join

Customer Information Company Name *

First Name *

Last Name *

Email *

Website

Phone *

Fax

Physical/Delivery Address Physical Address *

Physical Suburb *

Physical Post Code / Zip Code *

State *

Physical Country *

Billing Address Billing Contact Name *

Billing Address *

Billing Suburb *

Billing Post Code / Zip Code * Billing State*

Billing Country *

Company Information Registered Trading Name *

Years for trading under present ownership *

ABN / License * ABN for Australian businesses

Business Structure *

Owner's / director's details Company Owners / Directors details - Name *

Company Owners / Directors details - Address *

Company Owners / Directors details - Phone *

Credit Reference - 1

Current trade References (financial institution or courier will not be accepted as referees)

Name *

Address *

Phone *

Credit Reference - 2

Current trade References (financial institution or courier will not be accepted as referees)

Name *

Address *

Phone *

Terms and Conditions

Initial order: Full payment is required before delivery.
Pricing of goods: All prices quoted exclude GST and freight charges.
I/we consent to the information contained in this application being used for credit reference or credit reporting purposes by .
I/we agree to pay for all goods ordered through within 14 days of receiving the goods and invoice. No further statement or reminder will be issued.
I/we agree to notify the suppliers of any incorrect charges, damage to the goods in transit, or incorrect supply of the goods, within 24 hrs of receiving them.
I/we agree that a levy of 3% per month will be charged on overdue accounts.
I certify I am authorised to sign this credit application on behalf of the applicant and the above information is true and correct.
All delivered goods remain the property of until full payment is received.
Payment Facilities: Payment can be made either by cheque to Ho'okupu or by direct deposit into account. details below:

Bank: Commonwealth
BSB: 062514 A/C: 10248304
Remittance by e-mail: info@hookupusurf.com

You can also pay by credit card by phoning the shop on 02 6685 8861 (No extra fees).

I / we agree *

Send Application

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Wholesale Application