Registering a Credit Account

Applicant Name(Required)

First Last

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Telephone Number(Required)

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Email Address(Required)

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Are you registering a credit account for a(Required)

Sole Trader

Partnership

Limited Company

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What is your position at the Company?(Required)

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Registered Company Name(Required)

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Registered Company Address(Required)

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Registered Company Number(Required)

You can look this up at Companies House.

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Business Trading Name(Required)

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Business Trading Address(Required)

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Is this address also where you live?(Required)

Yes

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Do you own or rent this address?(Required)

Own

Rent

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What is your home address?

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Do you own or rent this address?(Required)

Own

Rent

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What is your business partners home address?(Required)

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Do they own or rent this address?(Required)

Own

Rent

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Do you have another business partner?

Yes

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What is your other business partners home address?(Required)

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Does your other business partner own or rent this address?(Required)

Own

Rent

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Date business commenced(Required)

DD slash MM slash YYYY

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Number of direct employees(Required)

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Reference: Name of Principal Supplier(Required)

Eg. Jewsons

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Reference: Your Contact at Supplier(Required)

Your account name, number or the name of your contact at the supplier.

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Reference: Your Credit Limit at Supplier(Required)

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What monthly credit limit do you request with Golden Larch?(Required)

Minimum £2000

Please enter a number greater than or equal to 2000.

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Signed by:(Required)

I/we hereby make a formal application for a credit account to an estimated monthly credit of £ 0 and agree to abide by the terms and conditions of sale. I/we appreciate that payment of accounts within your stated terms is of the essence of the contract.

First Last

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0% Completed!

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