Credit Application Form


 
Application for Credit Account
Customer Details (this form is to be printed after completion)

Name: Trading Name (if different)

Address:



Post Code:

Telephone No:

Co. Registration No.
(this section must be filled in):

Registered Office Address:

Holding Company Name:


Holding Company Address:

Finance Director:

Accounts Contact:

Payment Contact:

Company VAT No.:

Application is made for credit facilities for the maximum sum of:

Our purchase Ledger is:

Computerised
Manual
Facility to pay by BACS:
Yes
No
Our cheque runs are:
Variable
Fixed
Give dates of month
Facility to send a payment outside the cheque run:
Yes
No
We require a monthly statement: Yes
No
Our payments are made according to: Own Ledger
Supplier Statement
Trade References
Name:
Name:
Address:

Post Code:
Address:

Post Code:
Banking Details
Bankers:
Bank Sort Code:
Address:

Post Code:

Account No. :

Only use this button to completely reset the form.

Terms and Conditions: Back to top
We acknowledge that goods may not be supplied if the account is overdue or the order would take the balance over the credit limit. We accept that all product is shipped to terms of 30 days from the date of invoice.
I have read and accepted 's Terms and Conditions. (please tick box) Back to top
Please fill in this section after the document has been printed.
Signed for Applicant:

Date:

Print Name:

Print Title:

*Please note this form must be printed on your company letter heading and will not be submitted electronically.
Instructions:
Please print this form on your company letter heading. The completed form should use 2-3 sheets of A4 paper. Either post or fax the printed form to:

Secure Retail Limited
Walker Road, Bardon Hill,
Coalville, Leicestershire,
LE67 1TU England
Tel: + 44 (0)1530 511150 Fax: +44 (0)1530 511151