Credit Account Application

Business Contact Information

Fields marked * are required.

Trading Name *

Address 1 *

Address 2 *

Address 3

Postcode *

Contact Name *

Phone *

Fax

Email *

Accounts Payable Contact

Phone

Fax

Email

Limited Company, Sole Trader, or Partnership Information

Fields marked * are required.

Company Type *

▼

Company No. *

Year Commenced *

Sole Trader Name *

Year Commenced *

Address 1 *

Address 2 *

Address 3

Postcode *

Add additional trader?

Additional Trader Name *

Address 1 *

Address 2 *

Address 3

Postcode *

Partner Name *

Year Commenced *

Address 1 *

Address 2 *

Address 3

Postcode *

Add additional partner?

Additional Partner Name *

Address 1 *

Address 2 *

Address 3

Postcode *

Credit Information

Fields marked * are required.

Required Credit Limit *

£

Trade Credit Reference 1

Company Name *

Phone *

Email

Trade Credit Reference 2

Company Name *

Phone *

Email

How Information About You Will Be Used

We may share your information with credit reference agencies and other companies for use in credit decisions, for fraud prevention and to pursue debtors.

Agreement

Our Terms and Conditions. A copy of the terms and conditions will be emailed to you upon submission of this form.

I/We request a credit trading account with Fifteen Group Limited. I/We confirm that the details given are correct and I/We acknowledge receipt of a copy of your standard terms of sale, which I/We have read, understood and accepted.

Clear signature pad

Name *

Title *

Date