4DC NEW APPLICATION FOR A BUSINESS CREDIT ACCOUNT

To complete this form you must have the authority to open a credit account on behalf of your business and you will need:
- Contact Details for Accounts Department
- Delivery Details
- Company Structure & Registration Details
Accounts Department Details
Accounts Department Contact Name:*

First NameLast Name
Accounts Department Contact Position:*
Accounts Department Contact Phone Number*
Accounts Department Contact Phone:*

Area CodePhone Number
Accounts Department Contact Email:*
example@example.com
Accounts Department Address:*

Street Address

Street Address Line 2

CityCounty

Post Code
Your preferred method of Payment: *
Delivery Details
Will this Credit account be used for single or multiple delivery points?*

Single Delivery LocationMultiple Delivery Locations
Delivery Point Address:*

Street Address

Street Address Line 2

CityCounty

Post Code
Special delivery instructions:
Does the delivery point have 24 hour access or restricted?*

24 Hour AccessRestricted Access
If restricted access, what's the earliest time for delivery?*

:HourMinutesAM/PM Option
How many delivery points will charge to this credit account?*
If multiple, please list delivery points (Name & Postcode):*
Our transport department will be in touch to discuss delivery locations.
Company Structure & Details
Your company's Structure*
Your Company's Registered Name?*
Your Company's Trading Name if different to registered name?
Your company Registration Number:*
Your company Registered Address:*

Street Address

Street Address Line 2

CityCounty

Post Code
Name of proprietor:*

First NameLast Name
Trading As:*
Trading Address:*

Street Address

Street Address Line 2

CityCounty

Post Code
Home Address of Proprietor:*

Street Address

Street Address Line 2

CityCounty

Post Code
Partnership Trading Name:*
How many partners?*
1st Partner Name:*

First NameLast Name
1st Partner Home Address:*

Street Address

Street Address Line 2

CityCounty

Post Code
2nd Partner Name:*

First NameLast Name
2nd Partner Home Address:*

Street Address

Street Address Line 2

CityCounty

Post Code
3rd Partner Name:*

First NameLast Name
3rd Partner Home Address:*

Street Address

Street Address Line 2

CityCounty

Post Code
4th Partner Name:*

First NameLast Name
4th Partner Home Address:*

Street Address

Street Address Line 2

CityCounty

Post Code
Do you have a VAT registration number?*

YesNo
VAT Number:*
Credit Limit Requested: £*
Your required credit limit.
Trade Reference 2 - Company Name*
Trade Reference 2 - Address:*

Street Address

Street Address Line 2

CityCounty

Post Code
Trade Reference 2 - Phone Number*

Area CodePhone Number
Trade Reference 2 - Email*
example@example.com
Terms & Conditions
I confirm that I have read and accept the 4DegreesC Ltd Terms & Conditions (Type your name as confirmation)*
Please type your name as confirmation
Signatures

I hereby apply for Credit Facilities with 4DegreesC Ltd. I confirm that this information is true and complete and I have the authority to open this account. I agree to be bound by 4DegreesC Ltd Terms & Conditions which, together with this information, form the agreement. We may from time to time, undertake certain checks on you by consulting a licensed credit reference agency, trade references or bankers references for the purpose of establishing your creditworthiness and fraud prevention. The agency may record the search. You hereby give express consent for us to carry out such searches. No further notification will be given to you by us when we undertake such a search and we may do so at any time.
Your Name:*

First NameLast Name
Your Position:*
Your Email (a copy of this application will be sent to this address):*
example@example.com
Your Signature*

Clear
By clicking submit, you confirm that you have read and accept the 4DegreesC Ltd Terms & Conditions. You will recieve a copy of the completed application form by email.
Should be Empty:

Accounts Department Details

Delivery Details

Company Structure & Details

Terms & Conditions