customer account application form (application for...
TRANSCRIPT
The Former Bus Depot, Moulsecoomb Way, Brighton, East Sussex, BN2 4PN
Tel: 01273 608711
Fax: 01273 608712 [email protected]
CUSTOMER ACCOUNT APPLICATION FORM
(Application for a credit account – our terms are 30 days from date of invoice)
Customer Details
Full Business Name:………………………………………………………………………………………………………………………………………………………………………………………….
Address: ………………………………………………………………………………………………………………………………………………………………………………………….
………………………………………………………………………………………………………………………………………………………………………………………….
Post Code: ……………………………………….. Contact Name: ………………………………… Email: ………………………………………………………………………………
Nature of Business:… ……………………………………………………………………………………………………………………………………………...............................
Company Registration Number:……..…………………………………………………. VAT Number: …………………………………………………………………………………..
Account Type: Skip Hire [ ] Waste Disposal [ ] License No……………………………………………..
*Please send copy of Public Liabilities insurance on return with completed form
Invoice Details – To whom, and where are we to send our invoices to?
Full Business Name: …………………………………………………………………………………………………………………………………………………………………………….
Address: …………………………………………………………………………………………………………………………………………………………………………….
…………………………………………………………………………………………………………………………………………………………………………….
Post Code: ……………………………………….. Contact Name: ……………………………………………………. …Tel:………………………………………….....................
Fax: …………………………………………………………. Email (Invoices & Statements will be sent here)………………………………………………………………….
Bank Name/Address: …………………………………………………………………………………………………………………………………………..................................
…………………………………………………………………………………………………………………………………………………………………………..
Bank Account Name: …………………………………………………….. Sortcode: ………………………………. ACC No:…………………………………………………
Do you require Purchase Order numbers on all invoices? Yes [ ] No [ ]
Trade Reference - Please supply 2 full referees
Supplier Name: ……………………………………………. ……………….. Supplier Name: ……………………………………………………………
Address: ……………………………………………………………… Address: ……………………………………………………………
………………..……………………………………………. …………………………………………………………..
Telephone No: ……………………………………………………………… Telephone No: …………………………………………………………..
Contact Name: …………………………………………….................... Contact Name: ……………………………………………................
Email: ………………………………………………………………. Email: …………………………………………………..........
AUTH COMPANY SIGNATURE:………………………………………………………………….. PRINT: ……………………………………………………………………………….
Official use only
4yd £ 6yd £ 8yd £ 10yd £ 12yd £ RO/RO Haulage £ Tonnage £
Weighbridge Disposal Charge £ Min Charge £
Account Approved [ ] Account Rejected [ ] Signature:……………………………………………………………………