Holdsworth Account Application Form

Holdsworth Account Application Form

Account Application Form
Company Details
Are you a Sole Trader/Partnership or Registered 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.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
Special Delivery Requests

Account Details
Account Type

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.

Order Contact Details
Name

First NameLast Name
Telephone Number
Please enter a valid phone number.Format: 00000 000 000.
Sales/Order Email
example@example.com
Would you like to use our Online and App ordering system?
Would you like to be signed up to receive News and Promotions?
Spend Details
Expected Monthly Spend
Please note that there is a minimum order value of £150.00 on all accounts.

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
Print Name

First NameLast Name
Position
Date

DayMonthYear
Date
Account Manager
Prospect Account Number
Should be Empty: