Credit application

Customer Details
Customer Contact Name
Company/Establishment Name
Company Registration Number
Delivery Address
Postcode
Telephone
Ext.
Fax
E-Mail
Position
Maximum Credit Required
 
Are there any times when you can't receive delivery from us?
If "yes" please give details
 
Is your establishment part of a larger group?
If "yes" please give details
Name
Head Office Address
Postcode
Telephone
Ext.
Fax
E-Mail
Payment Office Details
Invoice address (if different from the delivery address)
Contact Name
Position
Address
Postcode
Telephone
Invoice to be sent to