Business / Trading Name
*
Business Type
*
Plc
Ltd
Partnership
Sole Trader
Details of People Authorised to Place Orders
Name
*
Position
*
Name
Position
Business Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Main Telephone Number
*
-
Area Code
Phone Number
Accounts Telephone Number
-
Area Code
Phone Number
Are any of the directors, owners or partners in this business an un-discharged bankrupt
*
Yes
No
Have any of the directors, owners or partners held any other credit accounts with us?
*
Yes
No
If so, please provide account name(s)
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Ltd / Plc Companies Only
Company Registration No
Date of Incorporation
/
Day
/
Month
Year
Date
#1 Directors Name
#1 Directors Home Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Director #2
Directors Name #2
Home Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Director #3
Directors Name #3
Home Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Stopper
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Sole Trader / Partnerships Only
Proprietor / Partner #1
DOB
-
Day
-
Month
Year
Date
Home Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Proprietor / Partner #2
Proprietor / Partner #2
DOB
-
Day
-
Month
Year
Date
Home Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Proprietor / Partner #3
Proprietor / Partner #3
DOB
-
Day
-
Month
Year
Date
Home Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Stopper
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Authorised Payment and Co Bank Details
Authorised Person #1
Authorised Person #1
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Authorised Person #2
Authorised Person #2
First Name
Last Name
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Stopper
Bank Name
*
Branch
Sort Code
*
Account Number
*
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Trade References
Trade Reference Name #1
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Current Credit Limit
Trade Reference Name #2
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Current Credit Limit
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Signed
*
Name
*
First Name
Last Name
Date
*
/
Day
/
Month
Year
Date
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