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Credit Application
1
Order History
2
Contact Details
3
Legal Entity
Have you ordered from us before?
Yes
No
Sorry, we require a trading history with us to proceed with a credit application
Contact details
Trading name
Customer name
Customer telephone
Customer email
Accounts contact name
Accounts contact telephone
Accounts contact email
Expected Monthly Spend €
€0 - €250
€250 - €500
€500 - €1000
€1000 +
No. of employees
0
1 - 5
5 - 10
10 - 25
25 - 50
50 - 100
100 +
Trading Address
Street Address
Address Line 2
City
County / State / Region
ZIP / Postal Code
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Entity
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Registered Company Number
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Street Address
Address Line 2
City
Post Code
Name of Proprietor
Date of birth
MM slash DD slash YYYY
Home Address
Street Address
Address Line 2
City
Post Code
How many years have you been trading?
Less than 1 year
2 years
3 years
3 - 5 years
5- 10 years
10 years +
Are you VAT Registered?
Yes
No
In considering your application we may search your record at credit reference agencies who may supply us with credit information as well as information from the electoral role. They will add to your record details of our search and your application and this will be seen by other organisations that make searches. We may also add to your record with the credit reference agencies details of your agreement with us and any default or failure to keep to its terms. These records will be shared with other organisations and used by us and them to help make decisions about credit, verify your identity, trace debtors, recover debt, prevent money laundering and fraud, and to manage your accounts. For these purposes we or they may make further searches. Although these searches will be added to your record, they will not be shared with others. By completeing this form you agree that we can use your information in this way. Please telephone us if you want to have details of those credit reference agencies from whom we obtain and to whom we pass information about you. You have a legal right to these details. You have a right to receive a copy of the information we hold about you if you apply to us in writing. A fee will be payable.
I confirm that the above details are correct and agree to the terms
In considering your application we may search your record at credit reference agencies who may supply us with credit information as well as information from the electoral role. They will add to your record details of our search and your application and this will be seen by other organisations that make searches. We may also add to your record with the credit reference agencies details of your agreement with us and any default or failure to keep to its terms.
These records will be shared with other organisations and used by us and them to help make decisions about credit, verify your identity, trace debtors, recover debt, prevent money laundering and fraud, and to manage your accounts. For these purposes we or they may make further searches. Although these searches will be added to your record, they will not be shared with others. By completeing this form you agree that we can use your information in this way. Please telephone us if you want to have details of those credit reference agencies from whom we obtain and to whom we pass information about you. You have a legal right to these details. You have a right to receive a copy of the information we hold about you if you apply to us in writing. A fee will be payable.
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