Credit Application Form

Company Details

Company Trading Name:

Registered Office Address:

Postcode: Tel No: Fax No:

Delivery Address:

Postcode: Tel No: Fax No:

Email Address: Website Address:

Company Registration No: VAT Registration No:

Accounts Contact: Purchasing Contact:

Credit Limit Required:

Please supply two trade references

Trade Ref 1:

Address:

Postcode: Tel No: Fax No:

Trade Ref 2:

Address:

Postcode: Tel No: Fax No:

Credit Terms

Payment is due 30 days from the end of the month of invoice

Declaration

I/We have read and understood the above terms and conditions and the trading terms printed overleaf / attached and I/We hearby agree and accept the aforementioned terms and conditions

Authorised Signature: Date:

Name: Position: