William Clark & Sons Ltd
Unit 9
24 Lisgorgan Lane
Upperlands
Co. Londonderry
BT46 5TE
Northern Ireland
New Customer Registration Form
Trading Title
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
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E-mail
*
example@example.com
Nature of Business
Credit Amount Required Per Month
Terms
*
Normal terms of trading are 30 days from date of invoice
VAT registration No.
Length of Time Traded As Company
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If Limited Company
Registered Office
Names of Directors
Company Registration
If Partnership or Sole Trader
1st Partner
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
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2nd Partner
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
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Trade References
Please add trade references
Full Name
Address
Contact Number
Account Number
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WE MAY MAKE A SEARCH WITH A CREDIT REFERENCE AGENCY, WHICH WILL KEEP A RECORD OF THAT SEARCH AND WILL SHARE THAT INFORMATION WITH OTHER BUSINESSES. WE MAY ALSO MAKE ENQUIRIES ABOUT THE PRINCIPAL DIRECTORS AND PROPRIETORS WITH A CREDIT REFERENCE AGENCY. BY PROVIDING YOUR DETAILS AND SIGNING THIS FORM YOU AGREE THAT WILLIAM CLARK & SONS MAY CONTACT YOU BY EMAIL, PHONE OR POST IN RELATION TO YOUR ENQUIRY. YOU CONFIRM YOU HAVE READ AND ACCEPTED OUR PRIVACY POLICY. PLEASE NOTE THAT FAILURE TO COMPLETE ANY PART OF THE ABOVE FORM MAY DELAY YOUR CREDIT ACCOUNT ACCEPTANCE. WILLIAM CLARK & SONS LTD. REGISTERED IN ENGLAND NO. NI054740. CORRECT AS OF MAY 2021.
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