Create Account

Hi,

If you are a Business or Organisation and would like to open a Business Account please complete the below registration form and Submit. We will take 48hours to process your Credit References. Then if your Business or Organisation qualifies, we will confirm the Account is open for you to start shopping as per the Terms approved.

If you would like to start shopping now, please do so but please note that this transaction to be processed / completed will require payment by Direct Credit or Credit Card, until your account is openned.

If it is your preference to use a hard copy application, you can download and complete a Credit Application here and fax to 07-5759333 or scan and email to sales@capesmedical.co.nz

Also please note that all Cash Customers are able to create an account at Checkout and all those items purchased are automatically added to the Sales Order / Favourites section in your Virtual Office.

If you would like to edit your saved details (i.e. Delivery Address, name, etc) in your Virtual Office, this can be done at Checkout next time you make a purchase.

If you have any issues or queries please give our friendly Capes Customer Services team a call on 0800 18 19 19 and we hopefully can help.

Thanks,

Company Name: *

Phone: *

Fax:

Trading Name: *

Member Organisation Number:

If you are a member of an organisation you will have been asked to fill this field in, otherwise please ignore this field as it's not required.

Referral source: *

Postal Address

Name: *

Street: *

Town/City: *

Post Code: *

Delivery Address (If different from above)

Name

Street

Town / City

Post code

Account's Details

Contact Name: *

Contact Email: *

Accounts Payable Contact: *

Accounts Payable Email: *

Nature of Business: *

Date Business Commenced: *

AVG Business Credit Required: * Under $1,000 $1,000-$9,000 Over $9,000

Bank / branch: *

GST Number:

Trade References

3 needed (not utilities, lawyers, accountants or banks)

Name: *

Address: *

Phone: *

Name: *

Address: *

Phone: *

Name: *

Address: *

Phone: *

Declaration

Payment goods will be invoiced on dispatch and payment is made on 20th month following invoice.
Ownership: Goods will remain the property of Capes Medical until fully paid for.
The information supplied is true and correct and that we are/I am authorized to make this application
I/We acknowledge having read the credit terms as per this application including terms &s; conditions, and undertake to abide by them and to settle all accounts due to Capes Medical in accordance with them.
Under the terms of the privacy act 1993, I/We authorize any person or business or organization to provide the company with such information as they require in response to their credit enquiries. I/We authorize the company to furnish to any third party, details of this application and any subsequent dealings that I/we may have with the company as a result of this application being auctioned by the company.
Interest on all overdue accounts is payable by the application at the rate of 2% per month from the due date for payment until the date of actual payment.
All costs and expenses (including debt collection charges and commission and/or solicitor's fee) incurred in recovering any overdue amounts will be paid by the applicant as a liquidated sum.

Applicants Name: *

Complete this section only
if you are eligible to purchase medicines

Asper our Medsafe obligation we are to comply that new applicants are correctly designated in the Capes Medical ordering system
and are authorized to access scheduled medicines (i.e., are scheduled as Prescription,Restricted or Pharmacy Only medicines)

Type of provider: Medical Practitioner Hospital Reg Nurse

Registration/License No:

Capes Medical require a copy of your medical license to be uploaded or faxed to 07 575 9333

Select file to upload:

Authorized Purchasers:

I agree to the terms and conditions.

Create Account

Postal Address

Delivery Address (If different from above)

Account's Details

Trade References

Complete this section onlyif you are eligible to purchase medicines

Complete this section only
if you are eligible to purchase medicines