30 Day Credit Application Form

Please complete all relevant sections of this form

1 All Applicants:
Company Name / Sole Trader:
Address:
Post Code:
Main Contact:
Contact Name:
Telephone:
Mobile:
Email:
Accounts Contact:
Tick if the same as above
Contact Name:
Telephone:
Mobile:
Email:
Credit Limit Requested:
Order Numbers Required:
Please send invoices via:
Email address for invoices:
2 Limited Companies Only:
Company Registration Number:
Registered Office Address:
Post Code:
3 Non Limited Companies and Sole Traders Only:
Name:
Address:
Years at this address:
Rented / Owned:
Name:
Address:
Years at this address:
Rented / Owned:
4 All Applicants:
Details of two trade references
1
Company Name:
Contact Name:
Address:
Telephone:
Fax:
2
Company Name:
Contact Name:
Address:
Telephone:
Fax:
5 All Applicants:
Declaration
I / We have provided the above information as a true and fair description of this applicant
I / We have no material facts that could affect our application
I / We have read and agree to adhere to The Company's terms & conditions of sale
The Company Reserve the right to perform a credit check on the applicant or individuals
Signed:
Print:
Position:
Date:
Please note, payment terms are 30 days from end of month:
Overdue accounts will be placed on hold.