Credit Application Form

CREDIT APPLICATION FORM

LSA Global Logistics
Company name*
Company name
Registered address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
When did your business start operating?*

DayMonthYear
Date
VAT number*
VAT number
Do you have an EORI number?*

YesNo
Please, confirm your EORI number:*
Is your trading address different from your registered address?*

YesNo
Company Trading Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Are you a UK registered business?*

YesNo
Please, confirm your company registration number:*
Contact

Main Contact & Accounts Contact Details
Main Contact Details*

First NameLast Name
Email*
example@example.com
Phone Number*
Accounts Contact Details*

First NameLast Name
Email*
example@example.com
Phone Number*
Credit Required and Payment Information
Currency*
Amount Of Credit Required Per Month*
Payments are strictly 28 days from date of invoice

Please note that LSA Global Logistics will require additional information if credit checks are unsatisfactory.
Bank Details
Bank name
Is your bank account located in the UK or in another country?

YesNo
Bank details on letter head paper

Cancelof
We understand that if this application is accepted a Credit Account will be opened on our behalf. We accept the terms of credit of LSA Global Logistics, under which payment of accounts must be made no later than credit terms agreed on your invoices. We understand that LSA Global Logistics, reserve the right to withdraw credit facilities at any time, and in the event of failure to pay accounts within your credit terms, shall render ALL unpaid accounts immediately payable and due.
Declaration

I declare that the information given on this form is true and accurate.
Position*
Position
Full Name*

First NameLast Name
Date*

DayMonthYear
Date
Signature*

Powered by Jotform SignClear
Should be Empty: