PAIDIA MARKA
Trading Name* Trading Since*
Trading Address* Suburb* Postcode* State*
NZBN or ABN Number* GST Registered?*
Name of Reg'd Company(if applicable)
Company Address* Suburb* Postcode* State*
Type of Business*Sole TraderPartnershipReg'd CompanyTrust
Retail Store*YesNo
If Yes, How many? *If you have multiple retail stores, please attach a list of trading addresses for each store.
Web sales*YesNo
Web address: * Web sales only via proprietary owned shopping cart on your own URL not via 3rd party sales/auction sites
Contact Name*
Phone Number*
Mobile Number*
Email*
Owner's Name*
Owner's Email*
*Required