Credit Account Form

COMPANY INFORMATION

Company Name

Address 1

Address 2

Town/ City

County

Post Code

Trading As

Switchboard No

Primary Fax No

Web URL

Credit Limit

Registered Company Address (If different from above)

Company Registration Number

VAT Number

CONTACT INFORMATION

Primary Contact

Primary Contact Name

Primary Contact Email

Primary Contact Title

Primary Contact Telephone Number

Accounts Payable

Accounts Payable Name

Accounts Payable Email Address

Accounts Payable Telephone Number

Invoices By Post

Please tick here if you would like invoices by post

TRADE REFERENCES

Reference 1

Reference 1 Company Name

Reference 1 Address 1

Reference 1 Address 2

Reference 1 Town/ City

Reference 1 County

Reference 1 Post Code

Reference 2

Reference 2 Company Name

Reference 2 Address 1

Reference 2 Address 2

Reference 2 Town/ City

Reference 2 County

Reference 2 Post Code

Signature

I confirm that I have authorisation to make this application on behalf of this company and all the details supplied above are correct at time of submission

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