Libra Drinks Account Form

Section B - Officers Details

We kindly ask that an individual holding one of the following positions within your business (Director, Proprietor/Owner, Chief Executive Officer, President, Chairperson, Treasurer) completes this form. If you do not occupy any of these positions, please consult with us before proceeding with the form, as it may be subject to rejection.
Name*

Forename(s)Surname
Date of Birth*

DayMonthYear
Date
Email*
example@example.com
Home Address*
Postcode*
Residential Status*
Number Of Year At Address*
Home Tel
Mobile No*
Name of Related Companies / Other Directorships*
Identification*
*Please note you will need to attach a photo of your identification at the end of the document.
Sign Here*

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Section C - Delivery Details

To guarantee the seamless, secure, and timely delivery of your first delivery, kindly provide us with comprehensive details that may assist our team. Additionally, including supporting images will enhance the clarity and accuracy of the provided information.
Delivery Information*
Access Restrictions
Cellar Drop Type*
Key Drop / Code
Delivery Details - Drop Photos

Please note you will be asked for the following images at the end of the account form; suggested parking area for lorry, venue frontage, cellar / delivery entrance (outside & Inside)

Section D - Requested Payment Method
Requested Payment Method*
Name On Card*
Last 4 digits*
Card Type*
Expiry Date*

MonthYear
Date
Account Name*
* The Company does not accept personal credit cards ** Business credit cards incur a 3% charge, business debit cards incur a 2% charge

Please note you will be required to attached an image of the front of your card at the end of the form
Account Number*
Sort Code*
Terms Requested*
Other (specify with reasons)*
NB Bank account name should agree to legal title

Section E - Trade References

Please Supply 2 Trade References - Please note, you will be asked to attached a copy of an invoice or statement at the end of the form.
Name*
Credit Limit*
Account No.*
Terms*
Name*
Credit Limit*
Account No.*
Terms*

Section F - Contact For Order
Primary Contact For Orders*
First Name
Primary Contact For Orders*
Last Name
Telephone
Mobile*
Email*
example@example.com
Would You Like To Receive Our Promotions Brochure *
Estimated Date Of First Order*

DayMonthYear
Date
Estimated Weekly Spend*
How Would You Like To Order*
What Categories Do You Plan On Ordering

DraughtCaskPackaged Beers & CidersSpiritsWineMineralsOther
Please List The Key Brands You Intend To Order*
Please list your top 10/20 lines, so we can ensure we have the stock available.

Account Manager Information

The Following Sections & To Be Filled In By Your Account Manager, If your Account Manager is not present, please tick no in the dropdown
Is Your Account Manager Present
Account Manager*
Date*

DayMonthYear
Date
WISM*
Group / Venue
Lead Generated By*
Venue Categorisation*
Additional Comments To Support Application

Bank Reference

In order to support your credit application, it may be necessary for us to request a reference from your bank. Kindly complete the information below to expedite the processing of your application.
Business Name*
Account Number*
Sort Code*
Signed*

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Instruction to your Bank or Building Society to pay by Direct Debit

To set up a direct debit for payments to Libra Drinks Wholesale Ltd, kindly complete the company's bank information provided below.
Name and full postal address of your Bank or Building Society branch*
Name Of Account Holders*
Account Number*
Sort Code*
Reference Number
Date*

DayMonthYear
Date
Instructions to your Bank or Building Society. Please pay Libra Drinks Wholesale Ltd Direct Debits from the account detailed on this instruction subject to the safeguards assured by the Direct Debit Guarantee.*

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Submit Your Application

Thank you for completing our application form. Our accounts team will carefully assess your account and reach out to you at the earliest opportunity.
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