Account Form

Account Form

( * Fields are Mandatory)

ACCOUNTS APPLICATION FORM Click here to download our New Account Application Form

Please return with a copy of your letterhead

COMPANY NAME

ADDRESS

POSTCODE

FAX No.

E-MAIL ID

ACCOUNTS CONTACT

SALES CONTACT

DATE FORMED:

* mm/dd/yyyy

VAT NO.

COMPANY REG. No.

PLEASE STATE THE NATURE OF YOUR BUSINESS

AFFILIATED COMPANIES

PLEASE GIVE THE DETAILS OF ANY AFFILIATION, e.g. BPMA, PROMOTA, PSI, ISP, PAGE, GCG

IS THE ABOVE THE FULL LEGAL TRADING STYLE OF THE COMPANY ?

Yes

IF NO PLEASE GIVE DETAILS

CREDIT LIMIT APPLIED FOR :

BANK	:	*
ADDRESS	:	*

UNTIL A CREDIT LINE HAS BEEN ESTABLISHED, INITIAL ORDERS WILL BE
SUPPLIED ON A PRO-FORMA BASIS

I CONFIRM THAT THE ABOVE PARTICULARS ARE TRUE TO THE BEST OF MY KNOWLEDGE AND
ACKNOWLEDGE THE CONDITIONS OF SALE
ATTACHED.

SIGNED	:
NAME IN CAPITALS	:	*

POSITION	:	*
DATE	:	* mm/dd/yyyy