James McCullagh B.B.S Accountant Ph: 09-2673628

    New Client Application

    SURNAME Mr/Mrs Miss/Ms(require) FIRST NAMES(require)
    DATE OF BIRTH(require)

    SPOUSE'S NAME (if applicable)
    ENTITY NAME (if applicable)
    TRADE NAME (if applicable)
    IRD NUMBER(S) include personal (e.g 123-123-123, require)

    Work phone (require) Work Fax:
    Mobile phone (require) Home phone:
    Email (require)

    Street (require)
    Town (require)

    Street (require)
    Town (require)

    MAILING ADDRESS (If different to business address)

    PREVIOUS AGENT (If applicable)

    I/We declare that the information given in this form is true and correct

    Privacy Act:

    I/We hereby authorise you to verify any of the above information with 3rd parties
    I/We understand that payment terms are on a cash basis payable on completion. If the assignment is ongoing work will be invoiced on a weekly basis
    I/We understand annual interest rate of 10% calculated daily will be charged on amounts owing 30 days after date of invoice and be compounded monthly.
    Collection costs will be in addition to the original amount invoiced
    If the applicant is a company I/we accept personal liability for all fees incurred by the company on the same terms, if the company fails to make payment as
    per these terms
    I/We understand that financial statements and other reports produced remain the property of James McCullagh until paid for in full
    I/We understand that an engagement letter will be sent to me detailing the terms of the relationship
    I/We authorise your agency to obtain my/our tax information from the Inland Revenue Department for all tax types. This can be obtained
    through all forms of communication and media. Also to register us for any new tax types as and when required.
    I authorise our organisation to act as my agent for ACC levy purposes for all associated entities. This authorisation allows our organisation to
    query and change information on my ACC levy account(s) through ACC staff, and through ACC Online Services. This authority will also
    allow our organisations’ main representative discretion to delegate access to my ACC information to other members of our organisation.
    Other delegated members of our organisation will also be able to query and change information on my ACC levy account.
    I authorise you to access the companies office register and maintain company details if applicable.

    Applicant(s) (require)
    Date: (require)