Customer Detail Form

In order for us to process a new order or send a proposal to a new customer we need to gather and verify your details. Please complete the form below and a member of our sales team will be in touch shortly.

Your Details

Full Company Trading Name

*

Telephone Number

Email Address

*

Registered Address

*

Organisation Details

Legal Structure

*

Company Registration Number

*

How many YEARS have you been at this address?

How many MONTHS have you been at this address?

Nature of Business

If Partnership, give full details (not initials) and private address(es) of ALL PARTNERS. Continue on a separate sheet if required.

References
Please provide a name, address and telephone number of TWO principal suppliers. It is company policy for us to carry out at least one reference.

Reference 1 (Required)

Company

*

Contact Person

*

Address

*

Telephone

*

Date Account Opened

/

Day

/

Month

Year

Annual Value of Credit

Please authorise us to make this references when required

*

I/We authorise you to take up references at any time from the above source.

Reference 2

Company

Contact Person

Address

Telephone

Date Account Opened

/

Day

/

Month

Year

Annual Value of Credit

Please authorise us to make this references when required

I/We authorise you to take up references at any time from the above source.

Confirmation
Your Full Name

*
Position/Job Title

*
Today’s Date

*

/

Day

/

Month

Year
Please confirm that all information you have provided is correct

*

I confirm that all information provided is correct
Should be Empty:

Customer Detail Form

Your Details

Organisation Details

References

Confirmation