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Customer Details
Customer Contact Name
Company/Establishment Name
Company Registration Number
Delivery Address
Postcode
Borough or County
Telephone
Ext.
Fax
E-Mail
Position
Maximum Credit Required
Are there any times when you can't receive delivery from us?      
If "yes" please give details
Is your establishment part of a larger group?
If "yes" please give details
Name
Head Office Address
Postcode
Telephone
Ext.
Fax
E-Mail
Payment Office Details
Invoice address (if different from the delivery address)
Contact Name
Position
Address
Postcode
Telephone
Ext
Fax
Invoice to be sent to
Organisation Type
LEA Name
LEA Number




Other - please give details
Sole Trader/Partnership Details
Partner 1:
Home Address
Postcode
Partner 2
Home Address
Postcode
Premises Type
Please select one item only















Declaration
I/We have completed this application form knowing that the particulars are correct to the best of our knowledge and belief. I/We have read and understand the terms and conditions of sale and agree to all the terms as detailed.

By signing this application, you give us your consent to pass your details to a licensed credit reference agency and that we may make periodic checks from time to time within the course of business to manage your account with us.

For a Sole Trader/Partnership the credit reference agency will register a search against your home address. All business partners must sign this form.
Name Name
Position Position
Date Date
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