application form - long term lease

Please complete the appropriate section for the purposes of dtr obtaining information from you for dtr's credit and securities enquiries.

Click here to download a PDF version of this form.

All New Business Customers to Complete

Please choose branch nearest to you : junkHendersonPanmureManukau City CentreMangere Town CentreOtahuhu Town CentreMt RoskillWhangareiHamiltonTaurangaRotoruaGisborneHastingsNew PlymouthPalmerston NorthWanganuiLower HuttWellingtonBlenhiemRiccartonDunedinInvercargillGreymouthRichard Sextone - Commercial ManagerDavid Smithson - Commercial ManagerKaren Cameron - Commercial Manager

Business Structure:

Sole Trader	Company	Partnership	Incorporated Society	Charitable Trust
Other (Please specify)

Full Legal Name of Customer:

Main Email Contact Address :  

Have you previously had an account with DTR?  Yes  No

If yes, please include name of previous account:

Trade References: (please include phone numbers)

NAME	PHONE

Company to Complete

Company Name:
Trading Name: (if different from Company Name)
Company Incorporation Number :
Certificate of Incorporation Attached?:
Postal Address:
Delivery or Physical Address:
Previous Address (if under 2 years):
Phone: Home
Phone: Business
Phone: Mobile
Facsimile:
Email Address:
GST Number:
Type of Business:
Estimated Annual Turnover:
Bank:
Branch:
Person Acting on Behalf of Company:
Name:
Position:
Email Address:
Facsimile:
Contact Telephone:
Contact Address:
Mailing Address: (if different)

Shareholder Details:

NAME	ADDRESS	PHONE	SHARES HELD

Directors Details:

NAME	ADDRESS	PHONE

Sole Trader to Complete

Name of Sole Trader:
Date of Birth:
Proof of Date of Birth : Please tick attached document	Birth Certificate  Drivers Licence  Passport
Postal Address:
Delivery or Physical Address:
Previous Address (if under 2 years):
Home Address:
Phone: Home
Phone: Business
Phone: Mobile
Facsimile:
Email Address:
GST Number:
Type of Business:
Estimated Annual Turnover:
Bank:
Branch:

Partnership to Complete

Partnership Name:
Postal Address:
Delivery or Physical Address:
Previous Address (if under 2 years):
Phone: Home
Phone: Business
Phone: Mobile
Facsimile:
Email Address:
GST Number:
Type of Business:
Estimated Annual Turnover:
Bank:
Branch:
Person Acting on Behalf of Company:
Name:
Position:
Email Address:
Facsimile:
Contact Telephone:
Contact Address:
Mailing Address: (if different)

Partnership Details:

NAME	POSTAL & EMAIL ADDRESS	DOB	PHONE	Extent of Partnership Share

Charitable Trust to Complete

Name of Trust:
Date of Trust Deed: (Including any subsequent amendments)
Postal Address:
Delivery or Physical Address:
Previous Address (if under 2 years):
Phone: Home
Phone: Business
Phone: Mobile
Facsimile:
Email Address:
Person Acting on Behalf of Company:
Name:
Position:
Email Address:
Facsimile:
Contact Telephone:
Contact Address:
Mailing Address: (if different)

Trustee Details:

NAME	POSTAL & EMAIL ADDRESS	DOB	PHONE	FACSIMILE NUMBER

Incorporated Society to Complete

Name of Incorporated Society:
Company Incorporation Number:
Certificate of Incorporation Attached?:
Postal Address:
Delivery or Physical Address:
Previous Address (if under 2 years):
Phone: Home
Phone: Business
Phone: Mobile
Facsimile:
Email Address:

Person Acting on Behalf of Incorporated Society:
Name:
Position:
Email Address:
Facsimile:
Contact Telephone:
Contact Address:
Mailing Address: (if different)

Collection of Information (Privacy Act)

I/We acknowledge that:

1. Personal information collected or held by DTR or a duly authorised agent (whether contained in this form or otherwise obtained) is provided and may be held, used and disclosed to enable DTR or a duly authorised agent to process this form for DTR's credit and securities enquiries.

2. The personal information provided in this application is collected by and will be held by DTR whose address is Building B, 8 Business Parade South, Greenmount, Auckland

3. I/We have the right under the Privacy Act 1993 to obtain access to and to request correction of any information held by DTR concerning me.

I/We authorise DTR to obtain at any time from any person or entity, including but not limited to those persons nominated in this form, any information DTR may require for DTR's credit and securities enquiries.  I/We authorise any such person to release to DTR any personal information that person holds concerning me/us.

Under the Unsolicited Electronic Messages Act 2007, DTR needs your consent to send you some types of commerical electronic messages (mostly marketing and promotional information).  If you do not wish to receive these sorts of messages from dtr, please tick the 'no' box below before dating this document.  If neither of the boxes are ticked dtr assume you want to receive emails and text messages.

Yes, I consent to receiving marketing and promotional electronic messages from you in the future.

No, I do not wish to receive any marketing of promotional electronic messages from you in the future.