HS Home Deliveries Customer Account Form

Customer Account Form

Please complete this form in Block Capitals
- Company Name*
- Humber services Contact:*
  
  First NameLast Name
- Name of Director(s)*
  
  First NameLast Name
- Invoicing Address*
  
  Street Address
  
  Street Address Line 2
  
  CityCounty
  
  Post Code
- Date of Incorporation*
  
  DayMonthYear
  Date
- Amount of Credit Required*
- Registered Address (If different)
  
  Street Address
  
  Street Address Line 2
  
  CityCounty
  
  Post Code
- Accounts Contact Name*
  
  First NameLast Name
- Accounts Contact Email*
  example@example.com
- Accounts Telephone No*
- Operations Contact Name*
  
  First NameLast Name
- Operations Email*
  example@example.com
- Operations Telephone No*
- Company Registration No*
- Company VAT No*
- Website Address*
- Invoice Requirements - All Invoices are sent via email to one requested email address. Please state the email address for your invoices*
  example@example.com
- 1st Reference
- 1.Name of Company
- 1.Contact Name
  
  First NameLast Name
- 1.Address
  
  Street Address
  
  Street Address Line 2
  
  TownCounty
  
  Postcode
- 1.Telephone No
- 2nd Reference
- 2. Name of Company
- 2. Contact Name
  
  First NameLast Name
- 2. Address
  
  Street Address
  
  Street Address Line 2
  
  TownCounty
  
  Postcode
- 2. Telephone Number
- User 1
  
  These details will be used for your new GSIT Credentials
- Access Levels (You will need to provide for each user)
  
  1 - Full Access: This includes all access to financial / Invoicing
  
  2 - Part Access: This includes access to route information / adding new orders to the system
  
  3 - Restricted Access: Warehouse Operative Level
- Name*
  
  First NameLast Name
- Email*
  example@example.com
- Username*
- Password*
- Access Level*
- User 2
- Name
  
  First NameLast Name
- Email
  example@example.com
- Username
- Password
- Access Level
- User 3
- Name
  
  First NameLast Name
- Email
  example@example.com
- Username
- Password
- Access Level
- Completed By (Authorised signatory)*
  
  Clear
- Signature*
  
  Clear
- Name of Signee*
  
  First NameLast Name
- Date*
  
  DayMonthYear
  Date
- Please Verify*
- Please be advised that all approved accounts must be settled within terms. Humber Services Ltd reserves the right to check the correctness of all information entered on this form with a third party. All Business of the company is transacted under Standard Trading Conditions.
- HS Home Deliveries Ltd
  
  Old Doncaster Road
  
  Wath Upon Dearne
  
  Rotherham
  
  England
  
  S63 7EE
- Should be Empty:

Customer Account Form

1st Reference

2nd Reference

User 1

User 2

User 3