Holdsworth Account Application Form

Account Application Form
Company Details
Are you a Sole Trader/Partnership or Registered Business (e.g Ltd Co/LLP)/Charity?
Business Name
Proprietor 1 - Personal Name

First NameLast Name
Proprietor 1 - Date of birth

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Proprietor 1 - Home Address

Street Address

Street Address Line 2

CityCounty

Post Code
Proprietor 1 - If you have lived at the above address for less than three years, please provide previous home addresses below

Street Address

Street Address Line 2

CityCounty

Post Code
Proprietor 2 - Personal Name

First NameLast Name
Proprietor 2 - Date of birth

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Proprietor 2 - Home Address

Street Address

Street Address Line 2

CityCounty

Post Code
Proprietor 2 - If you have lived at the above address for less than three years, please provide previous home addresses below

Street Address

Street Address Line 2

CityCounty

Post Code
Legal Entity Name
Trading Name (if different from above)
Registration No
Telephone Number
Please enter a valid phone number.Format: 00000 000 000.
Mobile Number
Please enter a valid phone number.Format: 00000 000 000.
Email
example@example.com

Address Details
Trading Address

Street Address

Street Address Line 2

CityCounty

Post Code
Delivery Address (If different from trading address)

Street Address

Street Address Line 2

CityCounty

Post Code
Delivery Details - Hours of Access

Opening TimeClosing Time
Delivery Details - Please confirm access times for any pedestrian zones involved in deliveries
Delivery Details - Delivery Point Location

Other - Please provide details

Admin Details
Accounts correspondence Address (If different from Trading Address)

Street Address

Street Address Line 2

CityCounty

Post Code
Accounts contact name

First NameLast Name
Accounts contact email
example@example.com
Email for Digital Invoices/Statements
example@example.com
Accounts contact Telephone Number
Please enter a valid phone number.Format: 00000 000 000.

Declaration
By submitting this form, I give permission for Michael I Holdsworth Limited to carry out the necessary verification and credit searches based on the information I have provided. I understand that these checks may leave a footprint on my credit record. I confirm that I am an authorised signatory, that I am over the age of 18, and that I have read and accept the Terms and Conditions of Trading.
Signature
Print Name

First NameLast Name
Position
Date

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Account Manager
Prospect Account Number
Should be Empty:

Account Application Form