Credit Account Form

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Credit Account Form

Fields marked with (*) are required.

Full Comapany Name: (*)

Trading Name (if different):

Email:

Address:

Postcode: (*)

Phone: (*)

Fax No:

Company Reg. No:

VAT No:

Are you part of a Group?

YES

Which Group:

Person responsible for paying the account:

Buyers Name:

For Partnership/Sole Trader – Home Address:

CREDIT REFERENCES:

(1)

(2)

Bank:

Account No:

Sort Code:

Terms: (*)

I agree to be legally bound by your Terms and Conditions, and provide a bank reference in support of this application to open a credit account. I agree to pay in accordance therewith for any goods/services supplied by JAGS. I confirm that I am duly authorised to provide this undertaking.

Name: (*)

Position in Company:

Please enter the following security code:

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