Application for Credit

Accessman Branch*

Your one credit application allows you an account in any of our Accessman branches nationwide


Legal name*

Postal address*

Street address*

Business Phone*

Fax

Email for Invoices*

Trade Name*

Post Code*:

Post Code*:

Mobile*:

Email Address*

Contact person for account queries*: (best time to contact)

Date Company Registered

Accountant

Solicitor

Company Registration No

Phone

Phone:

Purchase order required
 YES NO

Business Type*: ( Please tick )

Registered Company Partnership Trust/Club/Society Sole Trader/Individual 



Companies: Directors or
Partneships: Partners or
Sole Traders/Individuals: Business Owner*

Surname Full Christian Name Date of Birth Private Address Phone



Independent Trade References*: Nominate only business you have traded with for at least six months - not utilities,
solicitors, accountants or banks etc.

Name Phone



Personal Guarantee

Name Position Date



Signature*

Name Position Date



I have read and accept the terms and conditions

Accessman