Kockney Koi Application for Trade Account
Once your form has been submitted we will get back to you as soon as possible, if you have any questions please email sales@kockneykoi.co.uk
Are you a limited company
*
Yes
No
If Yes, please state Director(s) names here
Business Name
*
Previous trading name (if applicable)
Invoice Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Vat Number
Company Number
Delivery Address (if different)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Is there a Forklift on site at the delivery address
Yes
No
Upload your Proof of aquatic business. ie Pet shop license, companies house certificate
*
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Business Phone Number
*
Please enter a valid phone number.
Business website
Business email address
*
example@example.com
Time
*
Hour Minutes
AM
PM
AM/PM Option
Until
until
Hour Minutes
AM
PM
AM/PM Option
Days open for delivery
*
Monday
Tuesday
Wednesday
Thursday
Friday
Contact name for purchasing
*
First Name
Last Name
Purchasing email address
example@example.com
Opt in for emails of special offers and new product releases
*
Yes
No
Accounts Person
First Name
Last Name
Accounts Telephone
Please enter a valid phone number.
Accounts Email address
example@example.com
Owner(s) Name(s)
*
First Name
Last Name
First Name
Last Name
Owners Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Owners Home Number
Please enter a valid phone number.
Owners Mobile Number
*
Please enter a valid phone number.
Signed......
*
Print Name
*
First Name
Last Name
Date
*
-
Day
-
Month
Year
Date
Continue
Continue
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