New Trade Account Application

New Trade Account Application

Please complete all questions within this application form to ensure your account is processed as quickly and efficiently as possible. Please ensure that you have read and understood our terms and conditions of sale.
Applicant Details
Name*
Premises Name in Full*
Legal Status of Business*
Address of Premises (Delivery Address)*

State / Province
Is the Registered Name and Address the Same as Above?*
Registered Name and Address

State / Province
Contact Phone Number*
Email Address*
Has the owner or partner been involved in a failed company that left unpaid creditors?*
Please provide details below
Identification*

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Company Number
VAT Registration Number
Date Trading Started*

DayMonthYear

Person Responsible for Accounts Payable
Full Name
Position
Contact Phone Number
Contact Email Address
Is Delivery Address Same as Invoice Address
Invoice Address

State / Province
Preferred Telesales Day*
Preferred Delivery Day*
Marketing Preferences

PhoneEmailPost

Trade References

Please provide two trade references
Company Name
Email Address
Contact Phone Number
Company Name
Email Address
Contact Phone Number

Signature
Please sign in the box below to confirm the above details are correct. It is the applicant's responsibility to update Cellar Drinks Company Ltd with any change of circumstances.

By signing this form you are requesting to open a trade account with Cellar Drinks Company Ltd pending acceptance of your application.
Please sign in the box below*

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Full Name*
Position*
Date*

DayMonthYear
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New Trade Account Application

Applicant Details

Person Responsible for Accounts Payable

Trade References

Signature