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|APPLICATION TO OPEN A CREDIT ACCOUNT |

|Name & address of | |Credit Check: |

|applicant company | | |

| | | |

| | |For office use only |

|Invoice address if | |

|different from above | |

|Telephone No (inc. STD | |Email for invoices & statements: | |

|code): | | | |

|Contacts |Purchasing: |Payments: |

|Type of Business |Sole Trader Partnership Limited Company |

|Nature of Business | |

|If Limited Company |Registered Office Address: |

| | |

| | |

| | |

| |Company Registration No: |

|Bank Reference Name & | |

|Address | |

| | |

| |Bank Sort Code: Account Number: |

|Trade Reference (1) | |Credit Check: |

|Supplier Name & Address| | |

| | | |

| |Tel: Email: | |

| | |For office use only |

|Trade Reference (2) | |Credit Check: |

|Supplier Name & Address| | |

| | | |

| |Tel: Email: | |

| | |For office use only |

|Applicant |Signed: Position: |

| | |

| | |

| |Print: Date: |

-----------------------

DD Mandate acquired: Account approved by:

Insurance details acquired: Account opened:

O License acquired: DD passed to FC:

For office use only

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