| Email Address | |
| Company Name | |
| Trading Name (if different to above) | |
| Invoice Address | |
| Telephone Number | |
| Fax Number | |
| Company Registration No | |
| Date of Registration | |
| VAT Number | |
| Date Company/Business Started Trading | |
| Nature of Business | |
| Buyers Contact Name | |
| Accounts Contact Name | |
IF NOT LTD, NAME OF PARTNERS/ PROPRIETORS: Forename | |
| Surname | |
| Home Address | |
| Telephone Number | |
| Fax Number | |
2 TRADE REFERENCES: Full Name 1 | |
| Address 1 | |
| Telephone Number 1 | |
| Fax Number 1 | |
| TRADE REFERENCE Full Name 2 | |
| Address 2 | |
| Telephone Number 2 | |
| Fax Number 2 | |
| Amount of Credit Required £ | |
| From (Date) | |
|
| | |
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