86 Plunket Ave, Manukau    |    www.kcprofessional.co.nz
Customer Care: 0800 447 814
Product Code Description Estimated Annual Usage in Cases Dispenser Code Number of Dispensers Description $ Full Retail Price of Dispenser including GST $ Total Value $ Supply Price for this agreement Minimum Annual Throughput in $ per Dispenser
Distributor Name:
Delivery Address/Instructions:
Customer Information *Please complete all details in this section

Same as above

I, the undersigned, acknowledge that:
  1. Loan

    If approved by KCNZ, the dispenser(s) described above will be supplied by Kimberly-Clark Professional (NZ), a division of Kimberly-Clark Australia Pty Limited (KCNZ) on loan on the condition that only KCNZ supplied products are used in the dispenser(s) and on the terms of this agreement. Once approved by KCNZ, this loan agreement may be brought to an end as follows:

    1. by you returning the dispenser(s) to KCNZ and bearing any associated costs of removal, return and rectification of premises; or

    2. by you purchasing the dispenser(s) from KCNZ for the Full Retail Price appearing above less a deduction of 33% for each full year that has elapsed since entering into this Agreement; or

    3. on KCNZ providing reasonable notice to you of the breach of this Agreement at any time, following which you will promptly arrange removal and return of the dispensers to KCNZ.

  2. Discounted Purchase Price:

    The dispenser(s) described above have been supplied by KCNZ at the Supply Price on the condition that only KCNZ supplied products are used in the dispenser(s) for a minimum period of 3 years. If you discontinue using KCNZ supplied product you must promptly pay to KCNZ the difference between the full Retail Price of the dispenser(s) appearing above and the Supply Price.

  3. Installation and Repair

    KCNZ will replace free of charge any dispensers which are faulty, unless these have been damaged or misused after installation. KCNZ takes no responsibility for any damage, loss or modifications made or suffered as a result of the installation or maintenance of the dispenser by any person.

  4. Use of Data

    By entering into this loan agreement, you are providing consent that KCNZ may collect and obtain data (excluding personal data) from you and/or your distributor and use this for the purpose of: KCNZ validating sales by your distributor to you (both in terms of price and volume); KCNZ undertaking certain marketing and advertising activities to you (including, providing advertising marketing or product information by email, newsletter etc., whether in conjunction with your distributor, or on its own); and KCNZ’s use of such information for its internal sales and market research purposes and, where the information is de-identified, in KCNZ’s external marketing activities.

  • By Ticking this box and entering my name below, I represent that I have the authority to enter into this agreement on behalf of the customer and I acknowledge that the terms and conditions of this loan agreement will apply between the parties upon the issuing of an email by KCNZ approving the supply of the dispensers described above:
The terms and conditions of this Agreement are accepted for KCNZ by:

By submitting this form you warrant that you have the authority to enter into the loan agreement and you agree to our Legal Statement and Privacy Policy .
Once this form has been fully completed and sent by you, it will be reviewed by KCANZ and you will receive an email confirmation that your dispenser supply request has been approved and is being processed.