New Account Application Form

Fill in our NEW ACCOUNT APPLICATION FORM below and submit.

indicates required fields YOUR COMPANY DETAILS:*
Full Company Name*

Trading Name*

Contact Name:*

Registered Address:

Address line 1:*

Address line 2:

Town/City:*

Postcode:*


Invoice Address if different:

Address line 1:

Address line 2:

Town/City:

Postcode:

Tel no:

Fax no:

Email:

Company Registration No:*

VAT Registration No:*

Year Company Established:*

Type of Company:*

Managing Director:*

Name of Parent Company If part of a group:


If not a limited company please give the proprietors name and address:

Name:

Address line 1

Address line 2

Town/City

Postcode


CREDIT AMOUNT REQUESTED:

Method of payment:*

Payment terms are strictly net and payable 21 days following month of invoice


YOUR BANK DETAILS:

Bank Name:*

Address line 1:*

Address line 2

Town/City*

Postcode*

Bank Sort Code:*

Bank Account Number*

How long has account been open:*

Please tick to agree to bank references being obtained where necessary


TRADE REFERENCES:

Name:*

Address line 1:*

Address line 2:

Town/City*:

Postcode:*

Tel no:*

Fax no:


Name:*

Address line 1:*

Address line 2:*

Town/City*:

Postcode:*

Tel no:*

Fax no:

1.I/We have read,understand and retain a copy of your conditions of sale (including the retention of the title clause and agree to trade in accordance with these for any goods supplied. We accept that the title of all goods supplied to us will remain vested in BalanceUK Limited until all amounts outstanding from us on any account have been paid in full to BalanceUK Limited.

2. I/We also agree to comply with your payment terms.

Please note this is a non secure form. If you prefer to post the application form back to us please download and fill in the attached PDF.


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