Business Type *
Primary Contact *
Primary Contact
Have any of the directors, owners or partners been declared bankrupt *
Terms Acceptance *
By filling in this form and ticking the confirmation box you confirm that the above information is correct and authorise us to contact your trade references and bank for further details. We may disclose information about the conduct of your account to credit reference agencies and other third parties. The information obtained from or provided to credit reference agencies or other third parties may be used when assessing further applications for credit terms, for debt collection, for tracing and for fraud prevention. I, the undersigned hereby confirm that if facilities are approved the account will be paid as per your normal terms.