New Account Request Form

Your Name*

Date of Application*

Your Email*

Monthly Credit Required*

Contact*

Full Company Name & Address*

Registration Number*

Company Tel:*

Company Fax:

Trade Reference 1

Trade Contact

Trade Tel:

Trade Fax:

Trade Reference 2

Trade Contact

Trade Tel:

Trade Fax:

If Partnership or Sole Trader. Please gives Names & Addresses of Proprietor(s):-

Payment Terms: First order to be paid on pro-forma basis by credit card, cheque or BACS.
If credit facilities are allocated by our underwriters, all other orders will become payable at the end of the month following the month of purchase.

Declaration by Credit Applicant

We hereby request you to open a credit account.

Directors/Partners Declaration:

I being an authorised officer of this business do agree that payment of all accounts will be received by you (our supplier) within your stated credit terms.
I/We appreciated that adherence to this obligation is the essence of the contract between us.

Authorised Officer: