DSL - Credit Account Application Form

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Credit Account Application Form

To apply for a 30 day credit account with us please complete and submit the form below. PLEASE NOTE: YOU MUST AGREE TO OUR 30 DAY (FROM DATE OF INVOICE) PAYMENT TERMS TO SUBMIT YOUR APPLICATION.

Customer Information

Company Name

Address 1

Address 2

Town / City

County / State

Post / Zip Code

Country

Telephone Number

Fax Number

Nature of Business

Company Registration Number

Contacts

Director / Owner

Telephone Number

Accounts Contact

Telephone Number

Finance Director

Telephone Number

Purchasing

Telephone Number

First Reference

Reference Company Name
Contact Name
Address 1
Address 2
Town / City
County / State
Post / Zip Code
Country
Telephone Number
Fax Number
Second Reference
Reference Company Name
Contact Name
Address 1
Address 2
Town / City
County / State
Post / Zip Code
Country
Telephone Number
Fax Number
E-mail Addresses
For Order Acknowledgements
For Invoices
For Statements
Other
Credit Limit Requested
Your Name
Your Telephone Number
Your Position
Your E-mail Address

Check this box to fully accept our 30 day payment terms taken from invoice date

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