Account Holder First Name *

Account Holder Last Name *

Email * This email address will be used to login

Preferred Contact Phone Number *

Company Legal Name * Invoices will be made out to this company

Company Trading Name (If Applicable)

Company Website

Account Password

Confirm Account Password

Mailing Address Street * Your delivery number and street e.g. 419 Grey Street

Mailing Address Line 2

Suburb *

Post Code *

City *

GST Number * You can get your GST Number easily from https://www.ird.govt.nz

New Zealand Business Number (NZBN) * You can get your NZBN easily from https://www.nzbn.govt.nz

HARP AVP Number (Specialist Vape Retailer Code e.g AVP-123) You can get your AVP easily from https://harp.health.nz/search/