Business Card Application Form

Transcription

1 Business Card Application Form Apply for your PGG Wrightson Rewards Business Card today and start earning the Rewards you deserve! Looking for a convenient way to manage your business spending needs while getting rewarded at the same time? The PGG Wrightson Rewards programme is perfect for your farm or business while providing more options, more convenience and more rewards. The programme consists of 2 key elements: A charge card that allows you to make purchases wherever Visa is accepted and receive discounts at selected merchants and partners; A points programme that rewards you for choosing to spend with PGG Wrightson and each time you use your Card. Current as of 1 November 2014 Helping grow the country

2 Guide to completing this form PLEASE READ THE FOLLOWING INFORMATION BEFORE YOU COMPLETE THIS APPLICATION FORM. Account Numbers Specify all your PGG Wrightson Account numbers so we can determine which ones are eligible to earn Rewards points. All accounts will be eligible for Rewards as long as they are part of the same legal entity. Primary Account Contact Person Specify who the primary contact person is should we need to contact them to discuss the Account. Rewards statements will only ever be sent to the Account Holder. Please provide an address should you wish to receive your statements via instead of post. Banking Passwords Each Card Applicant must create their own password on the application form. The banking password is used by ASB Bank as a security question when you activate your Card by phone. The password must contain a minimum of 6 alpha and 2 numeric characters. Each password must be unique (i.e. Card Applicants cannot share the same password) and may not contain any reference, in whole or in part, to any personal information on the application form such as your name or address. We recommend that you do not keep a written record of your password. Card Limits Each Rewards Business Card is issued with a Card limit in place as approved by PGG Wrightson. The Card limit forms a component of your overall PGG Wrightson Account credit limit, and transactions will be accepted on the Card up to the available Card limit. State how much you would like to be able to spend on the Card. The Card limit will need to last you from the start of the month to the 20th of the following month (when payment is due). Card limits are subject to approval by PGG Wrightson. Confirmation of Identity and Address For your security and to meet legal requirements, we need to verify the identity and address of all Card Applicants and the Account Holder/Authorised Signatory. Electronic Verification We will use the information you supply on this application form to electronically verify your details. Please include a photocopy of your NZ Driver s Licence with your completed application form. Face-to-face Verification If you do not have a NZ Driver s Licence or we are unable to verify your details electronically, we will need you to provide both identity AND address documents from the options below: Proof of Identity AND Proof of Physical Address SELECT ONE: Passport NZ Firearms Licence NZ Driver s Licence PLUS either a Birth Certificate or Bank Card i.e Credit, Debit or EFTPOS Card SELECT ONE: Bank Statement Utility Bill Rates Bill Insurance Policy Vehicle Registration Government Agency Statement The documents will need to be certified face-to-face by either a PGG Wrightson staff member or a trusted referee *. Main Rewards Contact Let us know who the Main Rewards Contact is so we can send communication about the Rewards programme, such as catalogues, to the right place. The Main Rewards Contact person can also opt in to receive additional communication such as promotions and specials via or text. Redemption of Points Rewards points earned through the programme can later be redeemed for products in our catalogues or on our website. Cardholders can earn points through the Business Card, but only the Account Holder and Primary Cardholder can redeem points for products, unless granted authority by the Account Holder. Signatures Ensure you have 2 signatures for EACH Card applicant the form needs to be signed by both the Card applicant AND the Account Holder (even if they are the same person). Rewards Membership Fees On enrolment in the Rewards programme, the following fees will be charged to your Account: $24.50 every 6 months for the first Card issued on an Account (known as the primary Card). $14.50 every 6 months for each subsequent Card issued on an Account (known as an additional Card). Processing Timeframe Please allow up to 10 business days for your application to be processed and your Rewards Card to arrive. If you have any questions please call us on *A trusted referee may include a Justice of the Peace, Lawyer, Medical Doctor, Police Constable, Registered Teacher or Chartered Accountant. They must sight the original documents and make a statement to the effect that they are true and correct copies and represent the identity of the named individual. The certified documents must also include the name, occupation and signature of the trusted referee and the date of certification. 2

3 Section 2 Primary Cardholder Details Title First Name(s) Surname of Birth d d / m m / y y y y Business Card Application Form To apply for a PGG Wrightson Rewards Business Card, you must first hold a PGG Wrightson Account and be 18 years of age or older. Account application forms are available from all PGG Wrightson and Fruitfed Supplies stores or by calling In considering your application, we may need to phone you for further details. PGG Wrightson retains the right to decline any application that does not meet our Declaration or Account Terms of Trade criteria. of Birth of Citizenship of Residence Current Home Address Same as Account physical address in section 1 Application for: New Rewards Customer Existing Rewards Customer Section 1 PGG Wrightson Account Details Account Number Account Name Account Physical Address This is the Account the Card(s) will be linked to Account Postal Address Same as Account physical address above Previous Home Address Complete ONLY if you have lived at your current home address for less than 12 months Account Account Card Details Name to appear on Card Must be in your name. Maximum of 20 characters. Other account numbers eligible to earn Rewards points: Accounts must be part of the same legal entity to be eligible to earn Rewards points. Otherwise a separate Reward Business Card application is required for those Accounts. Banking Password Minimum of 6 letters and 2 numbers. Do not use personal information. Account 1 Card Limit Requested Refer to Card Limits on page 2. $ Account 2 NZ Driver s Licence Number Card Version Number Account 3 Account 4 Primary Account Contact Person Full Name Section 5a on your NZ Driver s Licence Section 5b on your Driver s Licence Please include a photocopy of your NZ Driver s Licence with your application. If you do not hold a NZ Driver s Licence, refer to Confirmation of Identity and Address on page 2. Deliver my Card to: Account Postal Address Current Home Address / Statements will only ever be sent to the Account Holder. Please opt in to receive any of the following statements via the above address: PGG Wrightson Monthly Trade Account statement PGG Wrightson Rewards statement OFFICE USE ONLY: Approved Card Account Limit $ OFFICE USE ONLY C A R D I D - P Approved Card Limit $ 3

4 Section 3 Additional Cardholder Details Title First Name(s) Surname of Birth d d / m m / y y y y of Birth of Citizenship of Residence Current Home Address Same as Account physical address in section 1 Previous Home Address Complete ONLY if you have lived at your current home address for less than 12 months Card Details Name to appear on Card Must be in your name. Maximum of 20 characters. Banking Password Minimum of 6 letters and 2 numbers. Do not use personal information. Card Limit Requested Refer to Card Limits on page 2. $ NZ Driver s Licence Number Card Version Number Section 5a on your NZ Driver s Licence Section 5b on your Driver s Licence Please include a photocopy of your NZ Driver s Licence with your application. If you do not hold a NZ Driver s Licence, refer to Confirmation of Identity and Address on page 2. Deliver my Card to: Account Postal Address Current Home Address OFFICE USE ONLY C A R D I D - P Approved Card Limit $ 4

5 Section 4 Main Rewards Contact The Main Rewards Contact is the person to whom we will send communication to about the Rewards programme, including catalogues and promotions or specials. We will only communicate directly with Primary and Additional Cardholders on information pertaining to the Rewards Business Card. Nominated Main Rewards Contact is: (tick one) Same as Primary Cardholder in Section 2 Same as Additional Cardholder in Section 3 Other Contact (Complete the details below) Other Contact Details Title First Name(s) Surname of Birth d d / m m / y y y y Postal Address Same as Account physical address in Section 1 Section 5 Redemption of Rewards Points Rewards points earned through the programme can later be redeemed for products shown in our catalogues or on our website. We need to know who, other than the Account Holder and Primary Cardholder, has authority to redeem Rewards points tick all that apply: Main Rewards Contact in Section 4 Additional Cardholder in Section 3 Other provide details below Full Name Relationship 5

6 Section 6 Declaration Card Operators refers to both PGG Wrightson (PGW) and ASB Bank Limited. Account means your PGW monthly trade credit Account which will record Transactions and charges pursuant to the Card Conditions of Use and to the Terms of Trade of your Account. Card means any PGW Rewards Business Card issued by us under the Card Conditions of Use (including renewal, replacement, primary and additional Cards). 1. Business Spend I/We declare that, should my/our application be successful, the Card Limit to be provided to me/us by PGW be applied for business purposes. I/We acknowledge my/our Card will be linked to a nominated Account with PGW. These Accounts are used for business with PGW and I/we acknowledge that personal use is not their primary purpose. I/We understand that this facility will not be subject to the Credit Contracts and Consumer Finance Act 2003 and that any protections afforded to me/us under that Act do not apply. 2. I/We understand that, should the PGW Account nominated to this facility fall into arrears or exceed the Credit Limit for my/our PGW Account that the Card may be placed on HOLD or cancelled. All outstanding amounts are due on the 20th of the month. 3 I/We understand that redemption of Rewards points is subject to the PGW nominated Account being within its Terms of Trade (current and within the Credit Limit of that Account). 4. Account Holder I/We confirm and agree (and where the Account Holder is a company or a trust, we are authorised on behalf of the company or in terms of the trust deed to confirm and agree) that PGW is requested and authorised to issue the Card to all Applicants named in this application form. 5. Account Holder and other Applicants a) I/We acknowledge that the Conditions of Use which govern the operation of the Card and which will accompany the Card when it is issued apply to the Account Holder and any Applicants and I/we agree to comply with all of those Conditions of Use which apply to me/us. b) I/We confirm and agree that the Card Operators are authorised to direct debit all Charges incurred in respect of each Card issued to the Applicants to the PGW Account referred to above in this application. c) Notwithstanding that the Account may be in the name of some other person, company or entity, Applicants are jointly and severally liable with the Account Holder for all Charges incurred on that Applicant s Card and any additional Cards. d) I/We request the Card Operators to issue a Card to each Applicant, and renew and replace that Card until the Account Holder, an Applicant or the Card Operators cancel that Card. I/We acknowledge and agree that, if this application is accepted, the Account will be debited with a bi-annual membership fee of $24.50 for primary Cards and $14.50 for additional Cards. I/We further understand and agree that these fees are subject to change without notice. I/We understand that a copy of the Conditions of Use is available to the Account Holder and the Applicant on request and will accompany the Card issued to each Applicant if this application is accepted. I/We understand that the Card Operators are under no obligation to accept any of the applications made in this form. e) I/We permit the Card Operators (including their respective Group of Companies) to receive and exchange confidentially (between them and within each Card Operator) any information about me/us that they may require for the purpose of issuing and operating the Cards including, without limitation, information relating to the Account, any previous or subsequent account or card dealings in relation to the Cards or any other dealing that I/we may have had or may have (including in relation to any other card) with the Card Operators or their related companies. I/We understand that such information may be transferred confidentially to other companies in the PGW Group of companies and may be disclosed by the Card Operators to the Account Holder or to an Applicant. f ) I/We also permit and authorise the Card Operators to request at any time information about me/us from credit reporting agencies, financial institutions, credit providers and any of my/our employers (to confirm employment and salary details) and from the Account Holder and any other Applicant. I/We agree that the Card Operators may disclose information arising out of the operation or use of the Cards to credit reporting agencies, financial institutions and credit providers, which may be listed on the credit reporting agency s bureau and provided to the credit reporting agency s other subscribers. g) I/We agree that the Card Operators may use any such information for business purposes that include, but are not limited to, an Applicant s application for a Card, the approval process as it relates to purchases with the Card, the administration of any Account or any transaction the Account Holder and/or an Applicant may have with the Card Operators or with any other company in the PGW Group of companies, and for marketing purposes. h) I/We understand that, if an individual, I/we have the right to request access to, and correction of, the information held about me/us in accordance with the Privacy Act This information will be held at PGW, 149 Vogel Street, Dunedin. i) I/We agree that the Card Operators (or either of them) may produce the original or a copy or other reproduction of this application as evidence of the Application for (and the Account Holder s request and authorisation of the issue of ) the Cards. I/We certify that all of the information given by me/us in this application form is true and correct. 6. I/We confirm that I/we have read and understood the above declarations. Section 7 Signatures IMPORTANT: The Account Holder must counter-sign the form for EACH Card Applicant (even if the Account Holder and Card Applicant are the same person) giving them authority to use the Account to transact the Card. If the Account Holder is a Trust or Company, the Card Applicant(s) must obtain signatures or written permission from at least one of the listed owners/directors or authorised signatories of the Trust/Company giving them authority to use the Account to transact the Card. Primary Cardholder Signature Signature of Primary Cardholder Signature of PGW Account Authorised Signatory Additional Cardholder Signature Signature of Additional Cardholder Signature of PGW Account Authorised Signatory PGW Account Authorised Signatory to complete Full Name Position Signature of PGW Account Authorised Signatory Please complete the following only if you ARE NOT a Card Applicant Current Home Address Same as Account physical address in section 1 NZ Driver s Licence Number Card Version Number Section 5a on your NZ Driver s Licence Section 5b on your NZ Driver s Licence Please include a photocopy of your NZ Driver s Licence with your application. If you do not hold a NZ Driver s Licence, refer to Confirmation of Identity and Address on page 2. Please bring your completed application form, together with a copy of your NZ Driver s Licence, to your nearest PGG Wrightson store or office or post to: PGG Wrightson Rewards, Private Bag 1961, Dunedin OFFICE USE ONLY Business Master Number: Application Received Initials Credit Approved Signature Declined AR Masterdata Approved Signature Declined Customer Notified Initials Application sent to ASB Initials PGW