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?                                  Y N
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? Y N

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

If yes please list account names:
Sole trader only
Full Name:
Address :
Town/City :
County :
Postcode :
Full Name:
Address :
Town/City :
County :
Postcode :
	If less than 2 years please provide previous address:
Address :
Town/City :
County :
Postcode :

Is the business trading from the proprietors home address? Y N

Are the business premises owned by the proprietor? Y N

Allowable call off methods (e.g. fax/e-mail/ Written/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:
Address :
Town/City :
County :
Postcode :
Email
Telephone:
Address :
Town/City :
County :
Postcode :
Email
Telephone:

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:
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.

 

 Click here for postal address


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