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Reseller Account Information Reseller Account Information

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Your Personal Details * Required information
First Name:  *
Last Name:  *
Company Position  *
E-Mail Address:  *
Your Address
Delivery Address
Address 1  *
Address 2  
City:  *
Post Code:  *
Country:  *
Statement Address (if different from delivery address)
Address 1  *
Address 2  
City:  *
Post Code:  *
Country:  *
Your Contact Information
Telephone Number:  *
Fax Number:  
Company Details
Company Name:  
Website:  
VAT Number:  
Reg. Number:  
Business Type: PLC LTD SOLETRADER PARTNERSHIP LLP 
Type of Outlet BUSINESS DEALER RETAILER E-COMMERCE OTHER 
Business location HOME OFFICE SHOP OTHER 
Payment Method(s)
Business Type: Cheque Credit Card(3% surcharge) BACS/SWIFT Transfer Debit Card 
Other:  
Credit Request
I / We request you to open a Credit Account with a Proposed Credit Limit of £   pounds (GBP) excluding VAT, and an Agreed Credit Period of 14 days.
Bank Details
We may request a credit reference from your bank from time to time, at which time we will ask you to sign a consent. In the meantime, please enter your bank details below.
Bank Name   Bank Address
Account Number  
Sort Code  
References
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Company Type:  
Address:  
City:  
Country:  
Postcode:  
Telephone:  
Company Name:  
Company Type:  
Address:  
City:  
Country:  
Postcode:  
Telephone:  
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