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Application for credit facilities

Fields inboldaremandatory
Deliveries to:
Name:
Address:
Tel number:
Fax number:
Email address:
VAT registration no:
Statement to: (if different to above)
Address:
Tel number:
Fax number:
VAT registration no:
Contact name:
Length of time in business
Bankers name and address:
Bank account no:
Estimated monthly credit required:
Please supply the names and addresses of 2 companies with whom you trade regurlarly
1)
Contact name:
Tel number:
2)
Contact name:
Tel number:
Do not fill in this field!