Please Complete in Full to Enable Your Account to Be Set up As Soon As Possible

MILLSIDEBARROWCLIFFE D

ACCOUNT APPLICATION FORM

Please complete in full to enable your account to be set up as soon as possible.

Trading Name:

Delivery Address inc. postcode

Delivery Instructions to assist our driver(Give precise details of required time and location of delivery):

Purchase Order No Req’d Y / N If Y specifythe format

Statement / Invoice Address

Switchboard: Fax:

Accts + Tel E:

Buyer + Tel: E:

E mail for invoices to be sent

Type of Business:Sole Trader Partnership Limited Co. Other:______

How Long Trading Company Registered No

Are the Business Premises Owned Leased Rented

If Rented/Leased – Name and address of Landlord

If Sole Trader/Partnership please provide Full Name, Home Address & Telephone Number of ALL partners:
NameAddressTelephone
______
______
______

Continued Overleaf...... Page 1 of 2

Payment Method

15th of Following Month Only granted with two references and a satisfactory credit limit

Credit Required / Week Payment Method : Cheque BACS

Our Bank details for BACS payments are: Sort: 16-26-32, Account:10585142.

Please e-mail remittance to or Fax to 0115 9590268.

Trade References (Trade Referees should be able to speak for a credit figure as stated above).

Please ensure your last supplier is one of your referees, whom we will contact. Please provide Fax No’s.

NAME TEL No. FAX No Sent
1. ______
2. ______
3. ______

Credit will only be granted on receipt of satisfactory references and you will be advised of your Credit Limit. All Accounts are monitored by Creditsafe, and those in excess of their Credit Limit or Terms will be placed on Stop, if necessary without prior notice, and supply will not continue until payment has been cleared.

I/We agree to adhere to the Credit Terms extended to me/our Company. I/We understand thatMillside Barrowcliffe Limited reserves the right to surcharge any overdue accounts at the rate of 5% per month, and that should a Third Party be appointed in order to recover any sums due, I/My Company will be liable for any costs incurred.

Signed: ______Position:______

Print Name:______Date:______

The above must be signed by a Partner or Director.

Whom should we contact to advise the Account is open?

Please return this form to the address shown below as soon as possible, or fax to 0115 9590268. If you have any questions, please contact the Accounts department on 0115 852 3689.

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Accounts Department

Millside Barrowcliffe Limited

Hooton Street

off Carlton Road

Nottingham NG3 2NJ

Registered Office: Hooton Street, NottinghamNG3 2NJ

Co. Reg’n No 06742789

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