Full Company Name:

Date Company Started:

Web Address:

Address:
 

Town/City:

County:

Postcode:

Length at current address:

If less than 2 years please provide previous address:

Address:
 

County:

Postcode:

Is the statement address different to the invoice address?  Yes No

Address:
 

Town/City:

County:

Postcode:

Telephone:

Accounts Telephone:

Buying Telephone:

General email:

Accounts email:

Fax number:

Type of Business:  Public Limited Company Private Limited Company Sole Trader Partnership

Company Registration Number:

Parent Company:

Are any of the directors, owners or partners in this business un-discharged bankrupts?  Yes No

Have any of the directors, owners or partners in this business held any other credit accounts with the company? Yes No

If yes please list account names:

Sole Trader Only

Full Name:

Address:
 

Town/City:

County:

Postcode:

Is the business trading from the proprietor's home address?  Yes No

Are the business premises owned by the proprietor? Yes No

Allowable call off methods: (eg. e-mail/written/fax/verbal)
 
 
 

Allowable personnel (state below) if open to all please tick here  
Name:
Name:
Name:
Name:

Expected monthly credit:

Name of principle MD:

Financial controller:

Accounts contact:

Bank Name/Address
 

Account Number:

Sort Code:

Please provide two references

Name:

Address:
 

Town/City:

County:

Postcode:

Email:

Telephone:

Fax:

Name:

Address:
 

Town/City:

County:

Postcode:

Email:

Telephone:

Fax:

We give permission to contact the above references and our bank to provide references

MUST ME SIGNED/APPROVED BY A DIRECTOR, PARTNER OR PROPRIETOR OF THE BUSINESS

Name:

Email:

I have read and agree with the AL Batavon terms and conditions and I the undersigned confirm that all of the aforementioned details are truthful and correct

Click here to read the Terms and Conditions of Payment

Click here to read the Terms and Conditions of Sale

Director Approval: (Please print name)

Position:

Date:

By submitting the form you are giving authorisation for AL Batavon to contact credit references given above with regards to payment history, credit limits and account performance.

Please submit a credit application form for risk assessment purposes. Once your account has been approved signed confirmation of our terms and conditions must be received before your account will become active.

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