Client Application Form
Please fill out the form with your details to apply as a client.
Section 1 — Account request
Type of account required
*
Please Select
Cash on Delivery (COD)
Credit Account
Requested monthly credit limit
*
Estimated monthly spend with Mextrade
*
Please Select
Under £250
£250–£500
£500–£1,000
£1,000–£2,500
£2,500+
Section 2 — Business details
Trading name
*
Business type
*
Please Select
Restaurant
Caterer
Deli / Retail
Wholesale
Manufacturer
Hotel
Pub / Bar
Café
College / University
Export
Other
Company status
*
Please Select
Limited company
Sole trader
Partnership
Other
How long has the business been established?
*
How long has the business been under current ownership?
*
Part of a group or consortium?
Yes
No
If yes, please provide details
Section 3 — Main contact
Main contact full name
*
Job title
Email address
*
example@example.com
Phone number
*
Please enter a valid phone number.
Format: 00000000000.
Mobile number
Please enter a valid phone number.
Format: 00000000000.
Section 4 — Trading / delivery address
Trading address line 1
*
Trading address line 2
*
Trading town / city
*
Trading county
*
Trading postcode
*
Trading country
Trading contact name
*
Trading phone number
*
Please enter a valid phone number.
Format: 00000000000.
Trading email
*
example@example.com
Section 5 — Company information
Registered company name
Company registration number
Registered office address
Registered office postcode
Owner / partner full name
Date of birth
-
Month
-
Day
Year
Date
Home address
Postcode
Phone number
Please enter a valid phone number.
Format: 00000000000.
Second partner full name
Second partner date of birth
-
Month
-
Day
Year
Date
Second partner home address
Second partner postcode
Second partner phone number
Please enter a valid phone number.
Format: 00000000000.
Section 6 — Accounts / billing details
Accounts contact name
Accounts email
example@example.com
Accounts phone number
Please enter a valid phone number.
Format: 00000000000.
Invoice address same as delivery address?
Yes
No
Invoice address
Invoice postcode
Statement address same as invoice address?
Yes
No
Statement address
Statement postcode
Section 7 — Credit application details
Bank name
Account name
Sort code
Account number
Trade reference 1 supplier name
Trade reference 1 phone number
Please enter a valid phone number.
Format: 00000000000.
Trade reference 1 email or address
Trade reference 2 supplier name
Trade reference 2 phone number
Please enter a valid phone number.
Format: 00000000000.
Trade reference 2 email or address
Submit
Should be Empty: