Credit Account Application

Address Details Address Details

Applicants Full Name

Invoice Address

Post Code

Email Address

Tel. Number

Fax Number

Delivery address same as invoice? Delivery address same as invoice? Yes No

Delivery Address

Company Details Company Details

Company Name

Company Registration Number

VAT Registration Number

EORI Reg Number (where applicable)

Name(s) of Director(s) / Owner(s) / Partner(s)

What year was the company founded?

Type Of Business Type Of Business Sole Trader Partnership Charity Limited Company (Ltd) Public Limited Company Government company (i.e. Local Authority)

Nature Of Business Nature Of Business Grower Retailer Wholesale Local Authority Other

Please Explain

Payment Details Payment Details

Name of Bank

Sort Code

Account Number

Local Bank Branch Address

Preferred Invoice Currency Preferred Invoice Currency £ GBP € EUR

Purchase Order Required on Invoice? Purchase Order Required on Invoice? Yes No

Value of Credit Limit Required? (in £'s)

Trade References Trade References

Trade Reference 1 (address and tel. number)

Trade Reference 2 (address and tel. number)

Trade Reference 1 Email

Trade Reference 2 Email

Final Information Final Information

Please sign and date the below to confirm you accept the following terms and conditions: Please sign and date the below to confirm you accept the following terms and conditions:

I / We accept that any goods supplied will be in accordance with Kernock Park Plants Ltd "Conditions of Sale" - see link at base of this page I / We accept that any goods supplied will be in accordance with Kernock Park Plants Ltd "Conditions of Sale" - see link at base of this page

Full name

Date