"Credit Application Form"

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Credit Application Form
Business / Trading Name ___________________________________________________________________________________________________________________
Business Type:
Plc
Ltd
Partnership
Sole Trader
Details of People Authorised to Place Orders:
Business Address:
Main Tel No:
_____________________________________________
Name: ________________________________________________
__________________________
_____________________________________________
Position: ______________________________________________
Accounts Tel:
_____________________________________________
Name: _______________________________________________
__________________________
_______________Post Code______________________
Position:
Are any of the directors, owners or partners in this business an un-discharged bankrupt? Yes/No
Have any of the directors, owners or partners held any other credit accounts with us? Yes/No
If so, please provide account name(s): __________________________________________________________________________________________________________
Ltd / Plc Companies Only:
Company Registration No: __________________________________
Date of Incorporation: ____________________________
Directors Name: _______________________________________________ Home Address: ______________________________________________________________
____________________________________________________________________________________________________ Post Code: __________________________
Directors Name: _______________________________________________ Home Address: ______________________________________________________________
____________________________________________________________________________________________________ Post Code: __________________________
Directors Name: ________________________________________________Home Address: _____________________________________________________________
____________________________________________________________________________________________________ Post Code: _________________________
Sole Traders / Partnerships Only
Proprietor / Partner: ____________________________________________ Home Address: ______________________________________________________________
__________________________________________________________________________ Post Code: __________________________DOB:______________________
Proprietor / Partner: ____________________________________________ Home Address: ______________________________________________________________
__________________________________________________________________________ Post Code: __________________________DOB:______________________
Proprietor / Partner: ____________________________________________ Home Address: ______________________________________________________________
__________________________________________________________________________ Post Code: __________________________DOB:______________________
Name of People Authorised To Make Payment & Co Bank Details:
Trade Reference Name : __________________________________________________
Name:
_________________________________________________
Address: _______________________________________________________________
Direct No: _________________________________________________
______________________________________ Current Credit Limit: ______________
Email: ____________________________________________________
Trade Reference Name: __________________________________________________
Name:
_________________________________________________
Address: _______________________________________________________________
Direct No: _________________________________________________
______________________________________ Current Credit Limit: ______________
Email:_____________________________________________________
In processing your application for credit facilities we make enquiries of credit reference agencies and
other third parties who may record those enquiries. We may also disclose information about the
Bank Name: _______________________________________________
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
Sort Code: __________________ Branch: _______________________
hereby confirm that if credit facilities are approved the account will be paid as per your normal
monthly terms.
Acc No: __________________________________________________
Must be signed by a director, partner or proprietor of the business
Signed: ……………………………………………………………. Print Name: …………………………………………………….. Date: …………………………………….
This application form is provided in good faith by Top Service Ltd, a specialist credit information and credit control services provider for the construction industry.
Any accounts that remain overdue may be passed to Top Service Ltd for collection purposes.
Insert Your Logo Here
Insert Your Details Here
Credit Application Form
Business / Trading Name ___________________________________________________________________________________________________________________
Business Type:
Plc
Ltd
Partnership
Sole Trader
Details of People Authorised to Place Orders:
Business Address:
Main Tel No:
_____________________________________________
Name: ________________________________________________
__________________________
_____________________________________________
Position: ______________________________________________
Accounts Tel:
_____________________________________________
Name: _______________________________________________
__________________________
_______________Post Code______________________
Position:
Are any of the directors, owners or partners in this business an un-discharged bankrupt? Yes/No
Have any of the directors, owners or partners held any other credit accounts with us? Yes/No
If so, please provide account name(s): __________________________________________________________________________________________________________
Ltd / Plc Companies Only:
Company Registration No: __________________________________
Date of Incorporation: ____________________________
Directors Name: _______________________________________________ Home Address: ______________________________________________________________
____________________________________________________________________________________________________ Post Code: __________________________
Directors Name: _______________________________________________ Home Address: ______________________________________________________________
____________________________________________________________________________________________________ Post Code: __________________________
Directors Name: ________________________________________________Home Address: _____________________________________________________________
____________________________________________________________________________________________________ Post Code: _________________________
Sole Traders / Partnerships Only
Proprietor / Partner: ____________________________________________ Home Address: ______________________________________________________________
__________________________________________________________________________ Post Code: __________________________DOB:______________________
Proprietor / Partner: ____________________________________________ Home Address: ______________________________________________________________
__________________________________________________________________________ Post Code: __________________________DOB:______________________
Proprietor / Partner: ____________________________________________ Home Address: ______________________________________________________________
__________________________________________________________________________ Post Code: __________________________DOB:______________________
Name of People Authorised To Make Payment & Co Bank Details:
Trade Reference Name : __________________________________________________
Name:
_________________________________________________
Address: _______________________________________________________________
Direct No: _________________________________________________
______________________________________ Current Credit Limit: ______________
Email: ____________________________________________________
Trade Reference Name: __________________________________________________
Name:
_________________________________________________
Address: _______________________________________________________________
Direct No: _________________________________________________
______________________________________ Current Credit Limit: ______________
Email:_____________________________________________________
In processing your application for credit facilities we make enquiries of credit reference agencies and
other third parties who may record those enquiries. We may also disclose information about the
Bank Name: _______________________________________________
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
Sort Code: __________________ Branch: _______________________
hereby confirm that if credit facilities are approved the account will be paid as per your normal
monthly terms.
Acc No: __________________________________________________
Must be signed by a director, partner or proprietor of the business
Signed: ……………………………………………………………. Print Name: …………………………………………………….. Date: …………………………………….
This application form is provided in good faith by Top Service Ltd, a specialist credit information and credit control services provider for the construction industry.
Any accounts that remain overdue may be passed to Top Service Ltd for collection purposes.