AL Batavon Group | AL Distributors Accounts Application Form

Full Company Name

Date Company Started / /

Web Address

Address

Town/City

County

Postcode

Length at Current Address

If less than two years please provide previous address

Address

Town/City

County

Postcode

Is the statement address different to the invoice address? Y N

Address

Town/City

County

Postcode

Telephone

Accounts Telephone

Buying Telephone

General E-mail

Accounts E-mail

Fax Number

Type of Business

Public Limited Company

PrivateLimited Company

Sole Trader

Partnership

Company Registration Number

Parent Company

Are any of the directors, owners or partners in this business un-discharged bankrupts? Y N

Have any of the directors, owners or partners in this business held any other credit accounts with the company? Y N

If yes please list account names

Sole Traders/Partnerships Only - Home Address(es) of proprietor/all partners

Full Name

Address

Town/City

County

Postcode

Length at Current Address

If less than two years please provide previous address

Address

Town/City

County

Postcode

Is the business trading from the proprietor's home address? Y N

Are the business premises owned by the proprietor? Y N

Call Off Methods (eg. fax/e-mail/written/verbal)

Allowable Personnel (State Below)

If available to all please tick here

Name

Name

Name

Name

Expected Monthly Credit

Name of Principle MD

Financial Controller

Accounts Contact

Bank Name and Address

Account Number

Sort Code / /

Please provide two references

Full Name

Address

Town/City

County

Postcode

E-mail

Telephone

Fax

Full Name

Address

Town/City

County

Postcode

E-mail

Telephone

Fax

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

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

Name

E-mail

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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