Customer Details Form

Name of Business*
Address*
Phone Number*
Email*
Nature of Business
Year Established
Type of Organisation (please tick)*
- Sole Trader
- Limited Co.
- Partnership
- Other
Trading/as Name or Registered Co. Name*
Company Reg. No.*
VAT No.*
OWNERSHIP (OR DIRECTORS IF LIMITED CO.)
Name*
Title*
Name
Title
BANK REFERENCE
Bank*
Contact Name*
Address*
Telephone Number*
BIC*
IBAN*
TRADE REFERENCE 1
Business*
Address*
Contact Name*
Telephone Number*
Email*
TRADE REFERENCE 2
Business*
Address*
Contact Name*
Telephone Number*
Email*
By ticking this box I hereby authorise our bank to release any information necessary to assist in establishing credit. We certify that all information on this form is correct. We fully understand your credit terms and agree to timely and complete payment in consideration of credit.*
- I agree to all above terms.
Email
This field is for validation purposes and should be left unchanged.

OWNERSHIP (OR DIRECTORS IF LIMITED CO.)