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Account Application
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CUSTOMER ACCOUNT
APPLICATION FORM
 
Application Date
 
 
SPECIALIST GROUP LTD
Guinness Circle, Newbridge, Trafford Park
Manchester M171EB.
Tel. 01618720626 Fax. 0161 873 7778
E-mail: sales@specialistgr.com
 
 
 
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:
 
   
Credit Limit required:
 
 
 
 
 
ADDRESS & TELEPHONE NUMBERS OF PROPRIETOR(S) OR PARTNER(S) IF NOT A LIMITED COMPANY
(NOTE: This Must be fully if not a Limited Company or an account may not be granted)
 
Forename:
   
Surname:
   
D.O.B:
 
   
Address:
   
 
   
Post code:
   
Forename:
   
Surname:
   
D.O.B:
 
   
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:
 
 
 
 
 
APPLICANT'S BANK DETAILS
 
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:
Select Date
 
 
 
 
 
THE FOLLOWING MUST BE COMPLETED:
origin of Lead / Classification?
(Please tick appropriate box)
 
ASM (Area Sales Manager)
PR
Exhibition
Internet
Other
 
 
 
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