Registration

Account Application

Company Information

Full Trading Name

Telephone Number

Email Address

Business Address

Number Of Years Trading

Type Of Business

Estimated Annual Value Of All Purchases

VAT Number (if applicable)

Please attach a copy of a business letterhead

Reason For Completing The FormUpdate my account detailsApplying for a pro-forma cash accountApplying for a weekly credit accountApplying for a 30 day credit account

Trading StatusPLCLimited CompanyPartnershipSoletrader

Limited Company or PLC Details

Company Registration Number

Registered office if different from above

First Partner Or Sole Trader Details

Full name of proprietor or first partner

Home Phone Number

Date Of Birth

Home Address

Postcode

Second Partner Details

Full name of second partner

Home Phone Number

Date Of Birth

Home Address

Postcode

Account Contact Details

Payment Contact Details Name

Payment Contact Details Telephone Number

Payment Contact Details Email

Payment Contact Address

Payment Contact Postcode

Purchasing Contact Details

Purchasing Contact Details Name

Purchasing Contact Details Telephone Number

Purchasing Contact Details Email

Purchasing Contact Address

Purchasing Contact Postcode

Bank Details

This section is not required when applying for a cash account.

Credit Limit Required

Bank Details Name

Bank Details Telephone Number

Bank Details Email

Bank Details Address

Bank Details Postcode

Sort Code

Account Number

Trade References

This section is not required when applying for a cash account.

First Reference

Reference Name

Company Name

Position in company

Telephone Number

Fax Number

Bank Details Email

Bank Details Address

Bank Details Postcode

Second Reference

Reference Name

Company Name

Position in company

Telephone Number

Fax Number

Email

Address

Postcode

Acceptance

I/We understand and agree that all purchases made by me/us are subject to the terms and conditions of sale of Parksafe Automotive Limited from time to time enforce.

Signature

Signed by

Company Name

Position in company

To be signed by a director or office of the company if LTD