My Account

New Credit Account Application Request Form


	MAXIMUM MONTHLY CREDIT REQUIRED



COMPANY STATUS (Please tick appropriate box)


Limited Company	Partnership	Sole Trader



FULL TRADING TITLE

Trading Address



Postal Code

Phone Number	Fax Number	Email Address


If Ltd. Co., Company Registration No.		VAT Reg. No.



IF PARTNERSHIP / SOLE TRADER - Names and Address of all Principals

1.
2.
3.
4.


	Main Purchase Buyers	Tel. No

	Main Account's Person	Tel. No

	Provide any other information that may support your application e.g. brief details of outgoing contacts:









	TRADE REFERENCES

	Company Name	Company Name

	Address	Address


Post Code	Phone No	Post Code	Phone No

Contact Name

	COMPANY BANKER

	Name

	Address



	Postal Code


Phone Number	Fax Number	Email Address

This company uses a third party credit reference agency for credit assessment purposes.

In submitting a request for this Company to open a credit account, you are hereby providing us with your consent to carry out any credit reference searches that we deem necessary to support your application. These searches will be taken for credit information purposes only, and may be carried out on both your company and its Principals.

The credit reference agency may also keep a record of our enquiry and share that information with other businesses that may also make enquiries about the company and its Principals.

This does not affect your statutory rights.

You are also agreeing to abide by the Terms and Conditions of this Company in the absence of any written authority, strictly from this Company, to the contrary.

Declaration: I wish to open a credit account with DeliverPlus Limited.

I am authorised by my company to do so.

The applicant acknowledges having received a copy of the suppliers Terms & Conditions and agrees to the conditions therein.

I accept all terms and conditions


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