New Account Registration Form
Account Type
*
Cash Account (Pay as you go)
Credit Account
Full Name
*
First Name
Last Name
Date Of Birth
-
Day
-
Month
Year
Date Picker Icon
Address
*
Street Address
Street Address Line 2
City
County
Post Code
Phone Number
*
E-mail
*
example@example.co.uk
Trading Name
*
Company Trading Name
Registered company Name (if applicable)
Company Type
PLC (Public Limited Co.)
LTD (Private Limited Co.)
LLP (Limited Liability Partnership)
Partnership
Sole Trader
Other
Limited Companies/Partenerships:
Registration Number
Date of Incorporation
Your main business activity
Please Select
DIY
Joinery & Carpentry
Bricklaying
Landscaping
Plumbing
Painter
Roofing
Groundwork
Property improvement
Civils & infustructure
Business Address
Street Address
Street Address Line 2
City
County
Post Code
Previous Address (if at present address less than 3 years)
Street Address
Street Address Line 2
City
County
Post Code
VAT Number (if applicable)
Company number (if applicable)
Choose your local branch
*
Please Select
Tachbrook Leamington Spa
This branch will be your main point of contact
Credit limit required if applying for Credit Account
*
Do you require us to use order No.s/Job References on all invoices?
Yes
No
If yes, should they be
Verbal
Written
Credit Applictaions Only: Please give reference of any two people
Full Name
Address
Contact Number
Email
1
2
Credit Account Applications only: If you are a sole trader, please upload a proof of address, in the form of a (Utility Bill/Bank Statement). If you are limited company, we can accept a Bank Statement/Paying In Slip.
*
Browse Files
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Choose a file
Cancel
of
Credit Account Applications only: I/We the customer authorise you to carry out the necessary credit checks for the application.
*
Yes
No
Would you like access to your account online (via our website)?
*
Yes
No
Signature
*
Please verify that you are human
*
Continue
Continue
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