Company Name:

Company Reg. No:

Trading Name (if differentfrom above):

Address:

 

Post Code:

Telephone:

Fax:

E-mail:

Name of Proprietor (s):

 

Type / Description of business:

Date Business incorporated:

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Credit Limit required:

Forename:

Surname:

D.O.B:

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Address:

 

Post Code:

Forename:

Surname:

D.O.B:

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Address:

 

Post Code:

Previous address in last 5 years

Address:

Post code:

Telephone:

Address:

Post code:

Telephone:

Address:

Post code:

Telephone:

Address:

Post code:

Telephone:

Address:

Post code:

Telephone:

Banker's Name:

Address:

 

Sort Code:

Bank Account number:

PLEASE SUPPLY DETAILS OF TRADE REFERENCES
REFERENCE 1

Name:

Address:

 

 

Post Code:

Telephone:

Fax:

REFERENCE 2

Name:

Address:

 

 

Post Code:

Telephone:

Fax:

SALES REPRESENTATIVE

PAYMENT TERMS:Payments must be received by the end of the following calender month.

CREDIT CHECKS: We will make a search with a credit reference agency, which will keep a record of that search and will share that information with other business. We may also make inquiries about the principle director with a credit reference agency.

DECLARATION: I confirm that the information is correct and I give authority to approach credit reference agencies and bank for references.

Name:

Positions:

Date:

ASM (Area Sales Manager)

PR

Exhibition

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