New Customer Account Form
Please fill out the fields below in order for us to process your customer account application and raise your details within our CRM system.
Full Registered Company Name
*
Company Registration Number
*
VAT / Tax Number (If VAT Registered)
Registered Company Address
*
Street Address
Street Address Line 2
Town/City
County
Postcode
Main Contact
*
First Name
Last Name
Main Contact Email
*
example@example.com
Main Contact telephone number
*
-
Area Code
Phone Number
Accounts Email (Invoices to be sent to)
*
example@example.com
Accounts Contact telephone number
*
-
Area Code
Phone Number
Trade References
Please provide 2 trade references who you have dealt with regularly on a credit account structure.
Trade Reference 1 - Company Name
*
Trade Reference 1 - Company Address
*
Street Address
Street Address Line 2
Town/City
County
Postcode
Trade Reference 1 - Contact Email
*
example@example.com
Trade Reference 1 - Telephone Number
*
-
Area Code
Phone Number
Trade Reference 2 - Company Name
*
Trade Reference 2 - Company Address
*
Street Address
Street Address Line 2
Town/City
County
Postcode
Trade Reference 2 - Contact Email
*
example@example.com
Trade Reference 2 - Telephone Number
*
-
Area Code
Phone Number
Account Details
Please give us an indication of your account usage and requirements.
What is your preferred account type?
*
Pre-Payment Account
30 Day Nett Monthly Account (Credit check required)
Required Monthly Credit Limit (if 30 day)
Please upload a copy of your company bank details on letter headed paper.
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Declaration
The undersigned confirms all of the submitted details are correct to the best of their knowledge and is authorised to apply for a new account on behalf of the company detailed above. I consent to a credit check via Experian on the company detailed above.
Authorised Signatory
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