Applicants Name

Company Email Address

Company Name

Company Registration No.

Company VAT Registration No.

Registered Office Address

Date Commenced Trading

Company Type Company Type Sole Trader Limited Company Partnership P.L.C. Other

Owners Name and Address (Only Complete if NOT a Limited Company

Trading Name and Address (Include Postcode)

Director(s) Full Name and Address

Contact Telephone Number

Company Website Address

Order Acknowledgement Email Address

Invoice Postal Address (If Different to Trading Address)

Accounts Contact Telephone No.

Accounts Contact Email Address

Bank Name and Address

Bank Sort Code

Bank Account No.

No Of Years Bank Account Held

Trade Reference - (1) Company Name, Address and Telephone

Trade Reference - (2) Company Name, Address and Telephone

Authorised Person Name to Apply for Credit

Number