La Diva Drinks Customer Application Form

La Diva Drinks & Food Ltd.

Customer Application Form 2022
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. PLEASE DO NOT HESITATE IN CONTACTING EITHER YOUR SALES REPRESENTATIVE OR OUR ACCOUNTS DEPARTMENT IF YOU HAVE ANY QUERIES REGARDING THE COMPLETION OF THIS FORM. YOU WILL BE NOTIFIED ONCE YOUR ACCOUNT IS OPEN.
Legal Status of Business

Other
Limited Company Number
Vat Registration Number
Full Legal Title
Trading As
Invoice Address

Street Address

Street Address Line 2

CityState / Province

Post Code
Email (invoices/statements)
example@example.com

Person Responsible For Accounts Payable

Person Responsible For Ordering

Delivery Address (if different from invoice)

Director Information:

please attached one of the board of directors ID as well as a recent bill (3 months) addressed to the ID address:

Cancelof
Soletrader / Partnership / Members Clubs

please fill in below if you fall under this category

Number of Principal (sole trader) or Every Partner in the Firm:

Trade Reference

please supply details of TWO companies with whom you have/had traded with within the last 12 months.

Number of Principal (sole trader) or Every Partner in the Firm:

Number of Principal (sole trader) or Every Partner in the Firm:

Rows	Yes	No	Comments
is there adequate space to park, are there any parking restrictions?
is there adequate space to unload products safety?
is the route level or sloping downhill/uphill?
is the route free from steps / stairs? if not how many up or down?
are there any other obstructions?

Credit Application

If you would like to apply for a credit facility we will require you to fill in below information:
In consideration of La Diva Drinks & Food Ltd. agreeing to grant the above credit facilities and any alteration thereof. I/we the undersigned do hereby agree to personally guarantee and settle any and all debts of the aforementioned entity as and when due from time to time to La Diva Drinks & Food Ltd. I/we have not unduly influenced to enter this Personal Guarantee.

You are contractually obliged to notify La Diva Drink & Food Ltd. within 30 days of any change of address or circumstance relating to the Personal Guarantee.

Rows	Person 1	Person 2
Full Name
Private Home Address
Post Code
Position In Company
Telephone
National Insurance Number
Date of Birth
If you have lived at the above address for less than 12 months please supply prior residence.
Address
Post Code

La Diva Drinks & Food Ltd.