Regional Customer Credit Application & Account Setup

Regional Customer Credit Application & Account Setup – Europe & Asia

Welcome to Peli BioThermal! We’re excited to support your temperature-controlled packaging needs. Please complete this form so we can set up your customer account and review your credit application. All information provided will remain confidential and will only be used to establish and support your account with us.
Company Name*
Registered Address*

Street Address

Street Address Line 2

CityRegion / Province

Postal / Zip CodeCountry
Company Reg. No.*
VAT Number*
Telephone No.*
Please enter a valid phone number.Format: (000) 000-0000.
Name of address for invoicing purposes if different from above.
Contact Name*
Email Address*
Expected Monthly Purchases (£)*
BACSCheque
GBPEURUSDSGD
For Non-Limited Companies, please include Proprietor(s)/Partners Names
TRADE REFERENCES
Company Name*
Company Address*

Street Address

Street Address Line 2

CityRegion / Province

Postal / Zip CodeCountry
Company Telephone No.*
Please enter a valid phone number.Format: (000) 000-0000.
Company Email*
example@example.com
BANK DETAILS
Bankers*
Address*

Street Address

Street Address Line 2

CityRegion / Province

Postal / Zip CodeCountry
Account No.
Sort Code

Ship To Address*

Street Address

Street Address Line 2

CityRegion / Province

Postal / Zip CodeCountry
Delivery contact name*
Delivery phone number*
Please enter a valid phone number.Format: (000) 000-0000.
Shipping Method
Shipping Type*
Shipment Payment Type*
Your Shipping Account No*
Shipping Details for shipping address 1
Is there a loading dock to receive freight shipments?
Is a truck with a lift gate needed (additional fee)?
Do you have a fork lift or pallet jack?
Do you need inside delivery (the driver will carry the shipment through the threshold of the delivery location; additional fee)?
Is the shipping address classified as being in a residential area (additional fee)?
Will you require the shipping company to contact you with a delivery notification (freight only; additional charge)?
Warehouse/shipping department receiving hours:
Are there any other potential difficulties the delivery truck may have with getting the truck in and/or accomplishing the delivery?
Other Special Instructions
If using more than one shipping address, complete the sections below with shipping information, including any special instructions.
Ship To Address

Street Address

Street Address Line 2

CityRegion / Province

Postal / Zip CodeCountry
Delivery contact name
Delivery phone number
Please enter a valid phone number.Format: (000) 000-0000.
Shipping Method
Shipping Type
Shipment Payment Type
Your Shipping Account No
Shipping Details for shipping address 2
Is there a loading dock to receive freight shipments?
Is a truck with a lift gate needed (additional fee)?
Do you have a fork lift or pallet jack?
Do you need inside delivery (the driver will carry the shipment through the threshold of the delivery location; additional fee)?
Is the shipping address classified as being in a residential area (additional fee)?
Will you require the shipping company to contact you with a delivery notification (freight only; additional charge)?
Warehouse/shipping department receiving hours:
Are there any other potential difficulties the delivery truck may have with getting the truck in and/or accomplishing the delivery?
Other Special Instructions
DECLARATION

To be signed by a Company Director or an authorised signatory approved by the board of directors or a Partner/ Sole Trader/ Proprietor.

I/We agree to operate our account in accordance with the standard terms of sale outlined on the following page.

I/We agree to pay for goods by the 30th of the month following the month of delivery, (unless different terms are agreed and confirmed in writing). We understand that credit facilities may be withdrawn if payment terms are not adhered to or our credit limit with Peli BioThermal Ltd is exceeded.

I/We give consent to our bankers to disclose information on the above bank account for the purpose of establishing credit facilities.

I/We agree that Peli BioThermal Ltd may process, use, record and disclose the personal information in this application, to other organisations, for the purpose of credit assessment, reassessment, the detection, tracing and prevention of fraudulent activity, and the prosecution, recovery and tracing of debts.

I/We understand that credit checks, with a licensed credit agency, will be undertaken by Peli BioThermal Ltd in connection with this application, and that a record of that search will be retained by the licensed credit agency. Signature of this document will be taken as authorisation to carry out these searches.

I/We agree that Peli BioThermal Ltd may make enquiries, as they consider necessary, in connection with this, or any other future application with them or any other member of the Pelican Group.

Under the DATA PROTECTION ACT 1998 you have certain rights to receive a copy of the Personal Information which we hold about you for which a fee will be payable. If any data is inaccurate it will be corrected immediately. For a copy of this information please write to Peli BioThermal Ltd at the address above.
Signature*

Clear
Title*
Date*

MonthDayYear
Date
Should be Empty:

Regional Customer Credit Application & Account Setup – Europe & Asia

TRADE REFERENCES

BANK DETAILS

Shipping Details for shipping address 1

If using more than one shipping address, complete the sections below with shipping information, including any special instructions.

Shipping Details for shipping address 2