Test

Credit Application Form

Company Info

Full Trading Name

Company Reg No

VAT Reg No

Nature of Business

No Years Established

Registered Address

Street

City

Province

Postal Code

Country

Invoice Address

Street

City

Province

Postal Code

Country

Primary Finance Contact Details

Contact Name

Job Title

Phone Number

Email Address

Accounts Payable Contact Details

If different from above

Phone Number

Email Address

Credit Application

Would you like to apply for a credit account?

[radio* apply-credit-account use_label_element "Yes" "No"]

Amount of Credit Required

Trade References

Trade Reference 1

Company Name

Contact Name

Contact Email

Contact Phone

Address

A/C Open Since

Credit Limit

Trade Reference 2

Company Name

Contact Name

Contact Email

Contact Phone

Address

A/C Open Since

Credit Limit

Agreement to the Company’s Terms and Conditions of Sale

I have read and understood the Company’s Terms and Conditions for the Supply of Goods and Service and agree to abide by them. Details available here.

I confirm acceptance of the Company payment terms of 30 days from date of invoice.

(To be signed by an officer of the company or employee authorised to agree such matters.)

Signed

Full Name

Job Title

Date Signed