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Applicant’s Details

Full Legal Company Name *

Please enter Full Legal Company Name

Trading Name

Company/Applicant Email *

Please enter Company/Applicant Email

Physical Address

Your Physical Address

Building / Apartment Level, Unit Number

Postcode

Telephone *

Please enter Telephone

Fax

Postal Address

Postal Address the same as above

Your Postal Address

Building / Apartment Level, Unit Number

Postcode

Telephone *

Please enter Telephone

Fax

Company Details

Please describe the nature of your business and/or operations

$

Estimated monthly spend *

Please enter Estimated monthly spend

Do you currently use a courier company?

Yes

No

Choose an option

If Yes, please state the name of the company

Would you prefer to receive invoices via post?

Yes

No

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If No, please provide email address for email invoice *

Please provide email address for email invoice

Credit References

Please supply three – Not including banks, power, phone companies and no personal

Company 1 Name *

Please enter Company Name

Company 1 Telephone *

Please enter Company Telephone

Company 2 Name *

Please enter Company Name

Company 2 Telephone *

Please enter Company Telephone

Company 3 Name *

Please enter Company Name

Company 3 Telephone *

Please enter Company Telephone

Your organisation type *

Please enter your organisation type

If other, please describe

Year your organisation started

Is the company registered? *

Yes

No

Choose an option

Your company registration number

Contact Details

Decision Maker – Authorising the opening of Account

Title *

Please enter Decision Maker Title

Position *

Please enter Decision Maker Position

First Name *

Please enter Decision Maker First Name

Surname *

Please enter Decision Maker Surname

Email *

Please enter Decision Maker Email

Telephone *

Please enter Decision Maker Telephone

User – Contact relating to User of courier services

Contact details the same as Decision Maker

Title *

Please enter User Title

Position *

Please enter User Position

First Name *

Please enter User First Name

Surname *

Please enter User Surname

Email *

Please enter User Email

Telephone *

Please enter User Telephone

Accounts – Contact for accounts payable

Contact details the same as Decision Maker

Title *

Please enter Accounts Title

Position *

Please enter Accounts Position

First Name *

Please enter Accounts First Name

Surname *

Please enter Accounts Surname

Email *

Please enter Accounts Email

Telephone *

Please enter Accounts Telephone

Contact with Post Haste resulted from

Please provide names or details

Important: Please note that Post Haste Couriers Limited payment terms are the 20th of the month following the date of invoice/ statement.

The company reserves the right to withhold its services from any customer whose account is overdue until such time as the account is paid.

All consignments are carried subject to the Conditions of Carriage prevailing.

Consent of disclosure

I acknowledge that I have read and agreed to the terms of the contract and have accepted and agreed to the Conditions of Carriage and Consent of Disclosure. I state I am authorised to agree to these conditions on behalf of the organisation named.

Name *

Please enter Name

Position *

Please enter Position

Email *

Please enter Email

Confirm Email *

Please confirm Email

Date

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Applicant’s Details

Physical Address

Postal Address

Company Details

Credit References

Contact Details

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Applicant’s Details

Physical Address

Postal Address

Company Details

Credit References

Contact Details

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