Credit Account Application Form

Credit Account Application Form

Fixmart Ltd, Unit S, Springhead Enterprise Park, Springhead Road,

Northfleet, Kent, DA11 8HJ

01322 274226 I sales@fixmart.co.uk I www.fixmart.co.uk

Please Note: As a guide, Credit Account applications are normally only considered for acceptance if the account spend is likely to exceed £10,000 per annum and/or an order frequency of at least once a month. Existing trade accounts are regularly reviewed against this criteria.

If you don't feel you can meet this criteria, you can chose to register for a online account instead and pay for your orders by credit card.

Registered Company Name*

Company Trading Name (If Different)

Company Type*

Select or enter value

Company Registration Number*

VAT Registration Number

Requested Credit Limit*

Nature of Business*

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Please Provide Your Approximate Annual Turnover*

Estimated Potential Monthly Spend*

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Will The Account Spend Exceed £10,000 in 12 Months*

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Please List The Top Three Products You Envisage Buying From Fixmart*

Company Website*

Number of Years Trading*

Registered Office Address*

Trading Address (If Different)

Contact Telephone Number*

Phone

Contact Email*

Accounts Contact Name*

First Name and Surname

Accounts Phone Number*

Accounts Email Address*

Accounts Address As Above*

Select or enter value

Accounts Address

Trade Reference Company Name

Trade Reference Contact Name

First Name and Surname

Trade Reference Address

Treade Reference Telephone

Phone

Trade Reference Email

Business Bankers*

Business Bankers Address*

How Long Banked With*

Sort Code*

Main Account Number*

We may use a third party credit reference agency for credit assessment purposes.

In submitting this request, you are hereby providing us with your consent to carry out any credit reference searches that we deem necessary to support your application. These searches will be taken for credit information purposes only, and may be carried out on both your business and the owners of the business.

The credit reference agency may also keep a record of our enquiry and share that information with other businesses that may also make enquiries about the company and its Principals.

This does not affect your statutory rights.

Declaration:

'I confirm that I wish to apply for a credit account with Fixmart Ltd. I declare that I have full authority to make such an application.'

Please also view our Terms and Conditions and Privacy Statement

I have read and accepted the above and T&Cs*

I have read and accepted the Privacy Statement*

Contact Name*

First Name and Surname

Contact Position / Title*

Send me a copy of my responses

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