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| 1. FULL TRADING NAME OF APPLICANT AND TRADING ADDRESS | ||
| ______________________________________________________________________ | ||
| ______________________________________________________________________ | ||
| ______________________________________________________________________ |
| Tel:_____________________________ | Fax: ______________________________ | |||
| 2. (a) INVOICE ADDRESS (IF DIFFERENT) | 2, (b) DELIVERY ADDRESS (IF DIFFERENT) | |||
| _______________________________ | __________________________________ | |||
| _______________________________ | __________________________________ | |||
| _______________________________ | __________________________________ | |||
| 3. IF LIMITED COMPANY, REGISTERED OFFICE ADDRESS (IF DIFFERENT) | ||||
| ______________________________________________________________________ | ||||
| ______________________________________________________________________ | ||||
| COMPANY REGISTRATION No._______________________________ | CONTACT NAME ________________________________________________ | |||
| 4. IF PARTNERSHIP/SOLE PROPRIETOR GIVE FULL NAMES AND ADDRESSES OF ALL PARTNERS/PROPRIETOR | ||||
| ______________________________________________________________________ | ||||
| ______________________________________________________________________ | ||||
| 5. YOUR BANKERS NAME & ADDRESS | ||||
| ______________________________________________________________________ | ||||
| ACCOUNT NO. ____________________________________________ | SIGNED _______________________________________________________ | |||
| SORT CODE: ______________________________________________ |
(BANK SIGNATORY ONLY) |
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| 6. REFERENCES-NAME & ADDRESS AND TELEPHONE NUMBER OF TWO PRINCIPLE SUPPLIERS | ||||
| (i) ________________________________________________________ | (ii) ____________________________________________________________ | |||
| ________________________________ | ___________________________________ | |||
| ________________________________ | ___________________________________ | |||
| TEL: _____________________________________________________ | TEL: __________________________________________________________ | |||
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7. ** PLEASE ATTACH A COPY OF YOUR OFFICIAL HEADED NOTEPAPER ** |
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I/WE HEREBY REQUEST YOU TO OPEN A 30 DAY CREDIT ACCOUNT.
I, BEING THE THE PROPRIETOR/AN AUTHORISED OFFICER OF THE BUSINESS DO AGREE THAT PAYMENT OF ALL ACCOUNTS WILL BE RECEIVED BY YOU (OUR SUPPLIER) WITHIN YOUR STATED CREDIT TERMS. I/WE APPRECIATE THAT ADHERENCE TO THIS OBLIGATION IS THE ESENCE OF THE CONTRACT BETWEEN US. |
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| SIGNED _________________________________________________ | PRINT NAME ___________________________________________________ | |||
| POSITION _______________________________________________ | DATE _________________________________________________________ | |||
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