Account Application

Credit Account Application Form

Business/Trading Name *

Business Type *

Public Limited Company Limited Company Partnership Sole Trader

People Authorised to Place Orders

Enter the names of people authorised to order through your account.

Business address

Address *

Address (2)

Address (3)

Town/City *

Postcode *

County *

 

Main Tel Number *

Mobile Tel Number

Accounts Tel Number

Your email address *

 

1 *

Yes No

Are any of the directors, owners or partners in this business an un-discharged bankrupt?

2 *

Yes No

Have any of the directors, owners or partners in this business held any other credit account with us?

Limited / Public Limited Companies Only

Company Registration Number

Date of Incorporation

 

Director 1 Name

Director 1 Full Address

 

Director 2 Name

Director 2 Full Address

 

Director 3 Name

Director 3 Full Address

Sole Trader / Partnership Only

Proprietor/Partner 1 Name

Proprietor/Partner 1 Full Address

Proprietor/Partner 1 D.O.B

 

Proprietor/Partner 2 Name

Proprietor/Partner 2 Full Address

Proprietor/Partner 2 D.O.B

 

Proprietor/Partner 3 Name

Proprietor/Partner 3 Full Address

Proprietor/Partner 3 D.O.B

 

Bank Details

Bank Name *

Branch *

Account Number *

Sort Code *

 

Trade Ref 1 Name *

Trade Ref 1 Address *

Trade Ref 1 Credit Limit *

 

Trade Ref 2 Name *

Trade Ref 2 Address *

Trade Ref 2 Credit Limit *

 

Required Credit Limit *

The maximum monthly amount of credit you would require. The actual credit limit will depend on the outcome of this application.

 

1 *

Yes No

I confirm that to the best of my knowledge, all of the above information is correct.

2 *

Yes No

I understand that I have an obligation to adhere to your normal monthly payment terms [30 days net] and should I default on payment, legal action will be taken against me.

3 *

Yes No

I understand that as part of my account application, enquiries may be made to credit reference agencies.

The following must be completed by a director, partner or proprietor of the business.

Name *

Date *

Digital Signature *

By ticking this box I understand that I will be providing a digital signature.

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