CREDIT ACCOUNT APPLICATION If you would prefer to download and print out this application form and terms and conditions please click here, alternatively please fill out the form below and submit your details: Applicant’s Name (including Trading Name if appropriate) Trading Address Email Post Code Website Telephone Number Invoice Address if different Mobile Number Post Code Fax Number     BUSINESS DETAILS How long has business been established Account Contact How long has business been at present address Trade Contact Annual spend on Electrical Goods V.A.T. Number  LIMITED COMPANIES Company Registration No. Company Financial Year End Director’s Name (1) Director’s Name (2) Address Address Post Code Post Code Home Telephone Number Home Telephone Number  PARTNERSHIP/SOLE TRADER Partnership/Sole Trader Name Partner Name Address Address Post Code Post Code Home Telephone Number Home Telephone Number  TRADE REFERENCES (must not be related to or associated business of applicant) Trade Reference 1   Trade Reference 2   Name of Business Name of Business Contact Name Contact Name Phone Number Phone Number How many years have you dealt with them How many years have you dealt with them  BANK DETAILS Bank Name and Address Sort Code Account Number I request credit facilities with Midshires Electrical & Lighting Ltd, and if given I agree to settle our account in accordance with your Terms & Conditions, a copy of which is printed on the reverse of this Credit Application. I certify that I/We have checked the information on this form which to the best of my knowledge is correct. Print Name: Position: IF THE LIMITED COMPANY/SOLE TRADER HAS BEEN ESTABLISHED FOR LESS THAN 3 (THREE) YEARS OR IN OTHER INSTANCES AT THE BEHEST OF MIDSHIRES ELECTRICAL AND LIGHTING LIMITED INDEMNIFIED AGAINST ANY BREACH OR NON-OBSERVANCE THEREOF BY THE APPLICANT. In consideration of your agreeing to grant credit facilities to the Applicant described above I hereby unconditionally guarantee the performance of the Applicant under its obligations herein and within the Terms & Conditions that form an integral part of this application and I agree to indemnify and keep Midshires Electrical & Lighting Ltd. indemnified against any breach or non-observance thereof by the Applicant. Print Name Position Date     Please click here if you agree with these terms and conditions     Home | About Us | Services | Suppliers Links | Latest News | Contact Us