1 of 1 homeArama Account Application Form

PLEASE RETURN TO claire@homearama.co.uk10/02/2015 08:11

Signed Date

Contact

Post Code Post Code

I/We hereby request you to open a credit account and by signing this agree: (1) To accept the Terms and Conditions of Sale of "The Company", a copy of which we

acknowledge we can freely request (2) To pay all undisputed amounts within 30 days following the date of invoice unless otherwise agreed in writing (3) That full

title in goods the remains with "The Company" until all due monies are paid. (4) To maintain published SRP's and to undertake not to discount unless previously

agreed with "The Company" (5) I/We also confirm that above information is correct and that neither I/We have been refused credit for whatsoever reason. I/We

confirm that we are duly authorised signatories.

Name(s)

MAIN EMAIL ADDRESS (please

note this is mandatory)

Contact

VAT NUMBER (please note this is

mandatory)

Tel No Tel No Tel No

Post Code

County County County

Email

Address

Email

Address

Email

Address

Town Town Town

Contact

Street Street Street

Can you please give us 2 UK BASED Trade References for companies with whom you have traded for at least 1 year. If you

are a new company or have been trading for less than 12 months then please complete a 3rd Trade Reference

Supplier Supplier Supplier

Accounts

Warehouse

Buyer

Merchandiser

To enable us to ensure we are able to contact the correct person in the correct department could you please complete details below

Dept Contact Tel No Email Address

In the case of a Limited Company please provide the Names of ALL Directors and the Company Secretary below. In the case of a Sole Trader or Partnership please also provide the full

address of all parties involved. Without such information we cannot open a credit account nor can we trade with you on a pro-forma or other basis.

Position Name Address

Fax No

Account No

Sort Code

Your Full Ltd Company Name and

Trading As Name

Post Code

Have you or the company ever been

refused credit?YES / NO

County

Tel No

YES / NO

Town

Will you pay through the Bacs system YES / NOIf granted a Credit Account do you agree

to pay within 30 days of inv?YES / NO

Account

Name

Invoice

AddressBank Name

Street 2Bank

Address

Company

Reg No

Registered

Office

Years

Trading

Can you pay by Credit Card if so we

charge 2% handling fee

homeArama Ltd Cypher House Bampton Business Park South Bampton OX18 2AN T 01993 867075