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 (in dd/mm/yyyy format)

    Home Address

    Postcode

    Second Partner Details

    Full name of second partner

    Home Phone Number

    Date Of Birth (in dd/mm/yyyy format)

    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