Customer account application form

Yellow NZ Limited, PO Box 17345, Greenlane, Auckland 1546. Free call 0800 803 803

Please complete all sections which are relevant to you and your business

Business details

Registered legal name*

Trading name*

NZBN*

Business registration number*

Physical address

Postal address

Mobile number*

Phone number

Business Email*

Website

Advertising authority details

Main contact name*

Position/Role within the company*

Billing information

Billing email*

Preferred payment method*

Direct Debit

Recurring Credit Card

To enable us to complete a credit assessment of you / your business, we need to collect and hold information about you / your business which may be passed on to a credit reporting agency, and service is conditional on the outcome. Credit reporting agencies may include credit checks and any defaults in payments to Yellow in their database and share this information with others who wish to conduct a credit check on you / your business. You may access your information and ask us to correct anything that is wrong.

In consideration of Yellow providing services (whether on credit or otherwise), by ticking this box, you agree to Yellow’s Terms of Business and confirm that the information provided by you is true and accurate.

I have read and agree to the Terms & Conditions*