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HEIWA application form
** denotes mandatory field
** Legal Company Name  
** Trading Name  
Postal Address
** Physical Address  
** Phone  
Fax
After Hrs Number
** General email    
Secure email (please provide a secure e-mail address where we may send privileged information)
Web site

 

 
** Dealer Prinicpal  
Contact Person
Position
Cell phone number

 

 
Delivery Address
Delivery Port
NZ additional Transport Costs
** GST number  

 

 
Stock type
Dealership type
If franchised, which franchises held
Registered Motor Vehicle trader (MVT)
MVT number

 

 
Terms and Conditions

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