New Commercial Registration - KiwiGas Christchurch

If you regularly want any type of commercial gas, please register here.

NO ACCOUNT WILL BE OPENED FOR A COMPANY or PARTNERSHIP UNLESS THE PERSONAL GUARANTEE SECTION
IN THIS FORM IS COMPLETED BY ONE OR ALL COMPANY DIRECTORS or PARTNERS.

Type of business *	LTD Company Sole trader Partnership Govt Dept Trust
Full Legal Name ("Applicant") *
Trading Name *
Postal Address *
Delivery Address *
Phone
Fax
Mobile *
Accounts email *
Accountant name and phone *
Solicitor name and phone *
Accounts contact name *
New connection	Yes
Name of current gas supplier
Number and size of KIWIGAS cylinders be to supplied (i.e. 2 x 45kg) *
Prefered inital delivery date * note - there is no guarantee delivery will be this date * *
Delivery Instructions
Directors, Owners, Partners, Authorised Persons, or Trustees
Name \| Address \| Phone \| Date of Birth *
Location Test Certificate Number (if required)
Special Delivery Conditions/Equipment and gas bottles on loan
Authorisation *	Signed as an authorised signatory on behalf of the Applicant. I have read and agree to the Terms and Conditions**
Date of signing *
Personal Guarantee* - Full Name *
Personal Gurantee* - Position *
Personal Guarantee* - Signed date *

* PERSONAL GUARANTEE
In consideration of KIWIGAS extending credit to the Applicant, I/we, the undersigned, hereby jointly and severally
personally guarantee all debts incurred by the Applicant in respect of all goods and services supplied by KIWIGAS.
I/we may for all purposes be treated as the Applicant and KIWIGAS shall be under no obligation to take proceedings
against the Applicant before taking proceedings against me/us.

**Please read commercial terms and conditions here before submitting a new account application.