CUSTOMER INFORMATION FORM

PLEASE ENSURE THAT ALL SECTIONS OF THE FORM ARE COMPLETED

CUSTOMER
INFORMATION FORM

PLEASE ENSURE THAT ALL SECTIONS
OF THE FORM ARE COMPLETED

    Company Name
    Trading Name
    ( IF DIFFERENT FROM ABOVE)
    Address
    Post code Mobile
    Accounts Payable Contact
    FAX
    Accounts Payable Email
    Trading Style Limited Co Sole Trader Partnership
    COMPANY REGISTRATION NO V.A.T NO
    DATE BUSINESS ESTABLISHED
    Sort Code Account No
    BANK NAME & ADDRESS
    TRADING ADDRESS
    ( IF DIFFERENT FROM ABOVE)
    POST CODE
    TELEPHONE NUMBER FAX NUMBER

    FOR SOLE TRADERS / PARTNERSHIPS ONLY:

    PROPRIETORS NAME
    PROPRIETORS ADDRESS
    POST CODE
    TELEPHONE NUMBER FAX NUMBER

    I CONFIRM THAT THE INFORMATION GIVEN IS ACCURATE, THAT I AM AUTHORISED TO SIGN ON BEHALF OF THE APPLICANT

    COMPANY NAME SIGNATURE
    DATED
    Sales Rep Signature
    Dated

      Company Name
      Trading Name
      (IF DIFFERENT FROM ABOVE)
      Address
      Post code
      Mobile
      Accounts Payable Contact
      FAX
      Accounts Payable Email
      Trading Style
      Limited Co
      Soletrader
      Partnership
      COMPANY
      REGISTRATION
      NO
      VAT NO
      DATE
      BUSINESS
      ESTABLISHED
      Sort Code
      Account No
      BANK NAME & ADDRESS
      TRADING ADDRESS
      ( IF DIFFERENT FROM ABOVE)
      POST CODE
      TELEPHONE NUMBER
      FAX NUMBER

      FOR SOLE TRADERS / PARTNERSHIPS ONLY:

      PROPRIETORS NAME
      PROPRIETORS ADDRESS
      POST CODE
      TELEPHONE NUMBER
      FAX NUMBER

      I CONFIRM THAT THE INFORMATION GIVEN IS ACCURATE, THAT I AM AUTHORISED TO SIGN ON BEHALF OF THE APPLICANT

      COMPANY NAME
      SIGNATURE
      DATED
      Sales Rep
      Signature
      Dated

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