New Account Proposal Form

 
CUSTOMER NAME (IN FULL):
TRADING AS:
CONTACT NAME:
INVOICE ADDRESS:
Town/City:
County:
POSTCODE:
TELEPHONE NUMBER:
FAX NUMBER
 
STATEMENT ADDRESS:
 
 
Town/City:
 
County:
 
POSTCODE
 
STATEMENT CONTACT NAME:
 
STATEMENT TELEPHONE NO:
 
STATEMENT FAX NUMBER:
 
 
DELIVERY ADDRESS:
 
 
Town/City:
 
County:
 
POSTCODE
 
DELIVERY CONTACT NAME:
 
DELIVERY TELEPHONE NO:
 
 
COMPANY TYPE:
(If Limited Co. VAT Reg Number Too)
PARTNERSHIP:
SOLE TRADER:
LIMITED COMPANY NO:
OTHER (SPECIFY)
 
 
VAT NUMBER:
NUMBER OF YEARS ESTABLISHED:  
NUMBER OF YEARS AT TRADING ADDRESS:  
IS PURCHASE ORDER REQUIRED? (Yes or No)
ARE PRICED DELIVERY NOTES EXPECTED? (Yes or No)
FIRST ORDER NUMBER:
TOTAL STERLING VALUE OF FIRST ORDER (Ex. VAT) £
METHOD OF PAYMENT:
Cheque BACS Standing Order
BANK DETAILS
BANK NAME:
BANK ADDRESS:
POSTCODE:
BANK SORT CODE:
ACCOUNT NAME:
ACCOUNT NUMBER:
IF PARTNERSHIP OR SOLE TRADER:
1/ FULL NAME:
HOME ADDRESS:
Town/City:
POSTCODE:
TELEPHONE NUMBER:
 
MOBILE PHONE NUMBER:
 
 
2/ FULL NAME:
 
HOME ADDRESS:
 
 
Town/City:
 
POSTCODE:
 
TELEPHONE NUMBER:
 
MOBILE PHONE NUMBER:
 
PREVIOUS HOME ADDRESS IF LESS THAN 5 YEARS OR AN ADDRESS ON WHICH YOU APPEAR ON THE ELECTORAL REGISTER:
FULL NAME:
HOME ADDRESS:
Town/City:
POSTCODE:
TELEPHONE NUMBER:
MOBILE PHONE NUMBER:
TWO TRADE REFERENCES - THIS SECTION MUST BE COMPLETED - REFERENCES MUST NOT BE CASH & CARRY, SAME GROUP COMPANIES OR LOCAL RETAILERS:
FIRST REFERENCE - NAME:
ADDRESS:
Town/City:
POSTCODE:
TELEPHONE NUMBER:
CONTACT:
NUMBER OF YEARS OF TRADING WITH THIS COMPANY:
SECOND REFERENCE - NAME:
ADDRESS:
Town/City:
POSTCODE:
TELEPHONE NUMBER:
 
CONTACT:
 
 NUMBER OF YEARS OF TRADING WITH THIS COMPANY:  
I acknowledge receipt of your Terms and Conditions of trading and understand that all orders are supplied in accordance with these conditions. (Copy to be left with customer, also available on the website www.casemirchocolates.co.uk).
As per the Terms and Conditions of trading, I/we confirm that payment for goods and services supplied to me.us will be made within 30 days from the date of invoice.
Enter a tick here to accept out Terms and Conditions
AUTHORISED: 
CUSTOMER SIGNATURE:
 
PRINT NAME:
 
POSITION:
 
 
CUSTOMER SIGNATURE:
 
PRINT NAME:
 
POSITION:
 

PLEASE PRINT THIS FORM, SIGN IT AND SEND IT TO:

 
 CASEMIR CHOCLOATES LTD. 
 THE CHOCOLATE HOUSE 
TETHERDOWN 
MUSWELL HILL  
LONDON 
N10 1ND