Registration Form

New Customer Account Application :

Please complete to initiate a new or updated account at PRATTS GROUP
Full Name*

First NameLast Name
Trading name if relevant
Address*

Street Address Line 1

Street Address Line 2

TownRural RD (if relevant) Add N/A if not

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
Mobile Phone Number*

Area CodePhone Number
E-mail address*
Subscribe to our mailing list to receive our latest specials and product information*

Yes pleaseNo thank you
Authorised on your account
Who can order work/parts and be charged to your account eg spouse, workers name, sibling

Please give names of two companies we can contact for a credit reference (not electricity or phone) :

	Company	Contact Name	Contact Number
1
2

Please ensure that you sign the Signature Panel below to complete your application
Signature - Accepting Terms and Conditions*

Clear
Should be Empty:

New Customer Account Application :