Customer Application Form

Company Name*

Registered No*

Trading Name*

VAT Reg. Number*

Main Contact Name*

Position*

Head Office or Trading Address*

	Postcode*

(If Not Ltd) Proprietor Name
Full Private Address of proprietor

	Postcode

Type of Business*

Telephone number

Facsimile

Mobile*

E-mail*

Trading Currency*

Payment method

Reference 1:
Name*		Tel*		Fax

Reference 2:
Name*		Tel*		Fax