Credit Application Form

Essex Flour & Grain Co Ltd

Incorporating EFG Walter Clarke
Customer Details
Company Name
Address

Street Address

Street Address Line 2 (optional)

CityCounty

PostcodeCountry
Type of Business
Phone Number

Area CodePhone Number
Fax Number

Area CodeFax Number
E-mail Address
Owner / Directors Name

First NameLast Name
Name of person responsible for settling account /

First NameLast Name
Phone Number

Area CodePhone Number
Name of person responsible for placing orders /

First NameLast Name
Phone Number

Area CodePhone Number
Type of credit required

Bankers Details

Thanks for requesting a credit account with us, please provide the following information
Name of Bank
Address

Street Address

Street Address Line 2 (optional)

CityCounty

PostcodeCountry
Bank Branch
Sort Code
Account Number

Trade References
First Reference
Full Name

First NameLast Name
Company Name
Address

Street Address

Street Address Line 2 (optional)

CityCounty

PostcodeCountry
Phone Number

Area CodePhone Number
Second Reference
Full Name

First NameLast Name
Company Name
Address

Street Address

Street Address Line 2 (optional)

CityCounty

PostcodeCountry
Phone Number

Area CodePhone Number

Final Detials
Within London Congestion Charge Zone
Delivery Instructions: Please include prefered delivery times, points and days
Enter the message as it's shown
Representatives should note that credit facilities will not be granted without full bankers details. By clicking 'Submit' you are agreeing to the Terms and Conditions.
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