Holdsworth Account Application Form

Account Application Form
Company Details
Are you a Sole Trader/Partnership or Registered Business/Charity?*

Sole Trader/PartnershipRegistered Business/Charity
Business Name*
Proprietor 1 - Personal Name*

First NameLast Name
Proprietor 1 - Date of birth*

DayMonthYear
Date
Proprietor 1 - 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
Date
Proprietor 2 - 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.
Mobile Number*
Please enter a valid phone number.
Email*
example@example.com

Declaration
By submitting this form, I hereby 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 can confirm that I am an authorised signatory, I am over the age of 18, I have read and accept the terms and conditions.
Signature*

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Print Name*

First NameLast Name
Position*
Date*

DayMonthYear
Date
Account Manager
Prospect Account Number
Should be Empty:

Account Application Form