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Customer Account Request Form

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Full Name ^*

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What is your Email Address? ^*

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Please enter your phone number ^*

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Company Director Name ^*

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Company Name (Trading Name) ^*

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Shop Website ^*

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Company Reg Number ^*

Company House Number

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Company VAT number

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EORI Number (International only)

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Please enter your shop phone number ^*

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Business Address ^*

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Billing Address (if different)

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Shop Operating Times ^*

Opening/Closing Times

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Out of hours phone number ^*

In case of delivery issues or emergencies.

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Do you have a forklift? ^*

Yes

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Do you have any delivery restrictions?

Leave blank if you have none.

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PROOF OF SHOP ADDRESS: ^*

UTILITY BILL/BANK STATEMENT DATED WITHIN LAST 3 MONTHS ON HEADED LETTER PAPER.

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Maximum file size: 10MB

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PROOF OF YOUR IDENTITY ^*

Driving licence / Passport

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Maximum file size: 10MB

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Reference ^*

What other wholesaler can vouch for you?

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Where did you hear about us? ^*

Instagram

Facebook

Word Of Mouth

Shop Visit

Search Engine (google, bing, etc..)

Other

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Customer Account Request Form Submitted

When your account has been opened, your first payment must be made through BACS.

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