Credit Account Application

This form must be completed in full by a Director, Partner, Sole Proprietor or an Authorised person.

Company Name: *

Select business type: *
---Distributor / MerchantsMain ContractorRoofing ContractorFaçade ContractorLocal AuthorityOthers

Address: *

Post Code: *

Telephone:

Fax:

Email to receive company communication:

Invoice Address (if different):

Post Code:

Telephone:

Fax:

Email to receive invoices and statements: *

Company registered in the UK?: *
YesNo

Company Reg No: *

VAT Registration No:

Ltd Company:

Partnership firm:

If Partnership: Please enter your full name, home address with post code and date of birth.

Sole Trader:

If Sole Trader: Please enter your full name, home address with post code and date of birth.

PLC:

Part of a Group:

Trade References Must be 2 Independent Companies (Recommended):

Address:

Post Code:

Telephone:

Email:

Contact Name:

Address:

Post Code:

Telephone:

Email:

Contact Name:

Credit Limit: *

I / WE CERTIFY THAT IF CREDIT FACILITIES ARE GRANTED I / WE ACCEPT FULL RESPONSIBILITY FOR ALL PURCHASES FROM CARLISLE CONSTRUCTION MATERIALS LIMITED (CCM Ltd) AND THAT THE ACCOUNT WILL BE CONDUCTED IN ACCORDANCE WITH CCM Ltd TERMS AND CONDITIONS WHICH ARE STRICTLY 30 DAYS FROM DATE OF INVOICE.

Authorised Signatory: *

Position: *

Name in Block Capitals: *

Date: *

Please leave this field empty.