Account Application Form

New Customer Account Form
Customer Details
Applicant Name / Organisation Name: Invoices will be issued in this name
Trading Name:
Entity Type:

Limited CompanySole TraderPartnership
Incorporation Date:

DayMonthYear
Date
Company Registration Number:
Company Address:
Delivery Address (if different from above):
Company Registered Office Address: (if applicable)
Phone:
Email:
First Point Of Contact:
Preferred Method of Contact:
Are there any times you prefer not to be contacted?
Are there any days/times that we cannot deliver during?
Contact Details for Accounts
Name:

First NameSurname
Position:
Phone:
Email For Invoices:
example@example.com
Details of Directors, Shareholders or Partners
List all directors/shareholders or partners of your organisation (as the case may be). Please attach extra sheet if required.
Name:

First NameSurname
Position:
Date Of Birth:

DayMonthYear
Date
Home Address:
Phone:
Email:
example@example.com
Name:

First NameSurname
Position:
Date Of Birth:

DayMonthYear
Date
Home Address:
Phone:
Email:
example@example.com
Bank name (including branch):
Bank Account Number:
Bank Sort Code:
Trade references (include at least 2 major suppliers not paid by Direct Debit - but not telephone, power or credit card companies)
1st Trade Reference Name:
1st Trade Reference Phone:
2nd Trade Reference Name:
2nd Trade Reference Phone:
Credit limit requested (predicted monthly volume):
I/we confirm that I/we are trading in my/our own name and that I/we accept full responsibility for all accounts supplied to this address. I/we undertake to pay for all goods which have been supplied and invoiced by the 21st of the month following delivery.
Signed:

Clear
Date:

DayMonthYear
Date
Should be Empty:

New Customer Account Form

Customer Details

Contact Details for Accounts

Details of Directors, Shareholders or Partners