Test Form Credit Application -

Trade Card Application - Cash Account
Title*

MrMrsMissMsMx
Name*

First NameLast Name
Full Name of Organisation or Individual:*
Trading Name (if different):
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Previous Address (if less than 3 years):

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Landline Number:
Mobile Number:*
E-mail Address:*
Business Type*

Carpenter / JoinerDecoratorDIYElectricianGeneral BuilderGroundworkerLandscaper / FencerPlastererPlumberRooferSelf-Build /RefurbishmentOther*
*If Other - Please Specify
Estimated Monthly Spend*

£0-£499£500-£999£1000+
Select an Option for Proof of Identity*

PassportUtility BillDrivers License
Proof of Identity (e.g., Utility Bill, Drivers License, Passport):*

Cancelof

Would You Like a Login on Our Website? (to access your invoices, place orders etc)*

YesNo
By checking the box below, I the undersigned apply to Coomers Ltd for a Trade Card and declare the information given above is true and accurate. I confirm that I have read the “Conditions of Sale” on Coomers' website* and agree to become legally bound by them. Coomers Ltd reserves the right to terminate the Trade Card forthwith without notice.

*Conditions of Sale
Agreement and Terms*

By checking this box, I am signing as an Authorised Signatory of the Customer
Signed Above by*

First NameLast Name
Date of Signature*

DayMonthYear
Date
Please verify that you are human*
Should be Empty: