Account Application

Applicant

Company Name:

Applicant Name:

Address:

Company Reg No:

Post Code:

Registered Office

Same as Applicant Address

Company Name:

Applicant Name:

Address:

Company Reg No:

Post Code:

Contact Details

Tel No:

Fax No:

Email Address:

Accounts Contact Name:

Where did you hear about us?:

Trading Style (please tick)

Sole Trader Partnership Limited Company Other (please specify)

Agent responsible for obtaining account (if applicable):

Bank Details

Bank Name:

Account Name:

Tel No:

Address:

Post Code:

Name & Address of Proprietor/Partners (Where NOT a Limited Company)

1. First Name:

Surname:

Address:

Post Code:

Tel No:

2. First Name:

Surname:

Address:

Post Code:

Tel No:

Trade Reference 1 (required)

Company Name:

Address:

Post Code:

Tel No:

Fax No:

Company Reg No: (if applicable)

Trade Reference 2 (required)

Company Name:

Address:

Post Code:

Tel No:

Fax No:

Company Reg No: (if applicable)

I/We confirm the above details are correct. By ticking this box:
1) I/We accept your standard terms and conditions of sale as printed in the catalogue.
2) I/We agree that any personal data you provide to us can be passed to our credit insurer, credit reference agencies and information providers, insurance companies, intermediaries and agents and they may keep a record of it and pass it to their customers. The personal data will be used for credit risk assessment and insurance and other related purposes and we may also receive personal data from sources other than you.

I/we agree to the terms & conditions

Name:

Date DD/MM/YY:

Position:

Members area

account application

Applicant

Registered Office

Contact Details

Trading Style (please tick)

Bank Details

Name & Address of Proprietor/Partners (Where NOT a Limited Company)

Trade Reference 1 (required)

Trade Reference 2 (required)