Trading Name

Applicants Name

Home Address of main Partner

Invoicing Address

Date of birth

Telephone No:

Facsimile No:

Partnership

Sole Trader

e-mail:

Our Payment Terms are strictly 30 days nett

Request for us to contact your bank for a reference. Costs incurred will be met by the applicant

In processing your application for credit facilities we may make enquiries of credit reference agencies and other thrid parties who may record those enquiries. We may also disclose information about the conduct of your account to credit reference agencies and other third parties. The information obtained from or provided to credit reference agencies or other third parties may be used when assessing further applications for credit terms, for debt collection, for tracing and for fraud prevention. I the undersigned herby confirm that if credit facilities are approved the account will be paid as per your normal monthly terms, and I personally guarantee, jointly and severally, to indemnify you for any amount outstanding from time to time on the said account, in the event of non-payment by the company, in whose name such credit is hereby sought. I also agree, personally and on behalf of the company, to pay interest at the rate of 8% above base rate per annum on any amount outstanding for more than 30 days.

You can print this form off and sign it then send by fax or post it to us, if you fax it you have to sign a letter head  agreeing to the term on the above form and send by fax or post before the account can be made live ready for us by your company

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