Account Form

Credit is strictly subject to status and credit check, if your application for credit is successful, PSV Glass reserves the right to withdraw credit facilities or amend credit terms at any time.

1. COMPANY TRADE NAME

Company Trade Name:

Sole Trader (Go to 2):

Limited Company (Go to 3):

PLC (Go to 3):

2. ONLY Complete if Sole Trader or Partnership (then Go to 6)

Name & Private Address of Sole Trader or Principle Partner:

Name:

Address:

D.O.B:

Name & Private Address of Sole Trader or Second Partner:

Name:

Address:

D.O.B:

3. ONLY Complete if Private Limited Company (then Go to 4 or 5)

CORPORATE NAME (LTD / PLC):

Company Registration No:

VAT no:

REGISTERED OFFICE:

Post Code:

4. ONLY Complete if PART OF A SUBSIDARY or PART OF A LARGER GROUP (then Go to 6)

Details:

5. ONLY Complete if Private Company and NOT a subsidary of a large group (then Go to 6)

Name and Address of Major Shareholder:

Name:

Address:

D.O.B:

Name and Address of Major Shareholder:

Name:

Address:

D.O.B:

6. ALL Applicants Please Complete (then Go to 7)

Accounts Payable Address:

Postcode:

Main Accounts Contact:

Manager Responsible for Purchase Ledger:

Area:

Bus / Coach Operator

Specialist Glass Installer

Vehicle Builder

Vehicle Repairer

Specialist Parts Supplier

Telephone Number:

Fax Number:

Email:

Telephone Number:

Fax Number:

Email:

7. ALL Applicants to Complete (then Go to 8)

Bank Details

Name:

Address:

Postcode:

Sort Code:

Account Number:

9. ALL Applicants to Complete (then SIGN BELOW)

Invoices, POD's and Copies of Signed Worksheets will ONLY be sent to ACCOUNTS ADDRESS entered in '6' Above

FIRST DELIVERY ADDRESS

Depot Name:

Address:

Telephone Number:

Primary Contact:

Telephone Number:

Must ALL Orders be accompanied by an order number?

SECOND DELIVERY ADDRESS

Depot Name:

Address:

Telephone Number:

Primary Contact:

Telephone Number:

Must ALL Orders be accompanied by an order number?

THIRD DELIVERY ADDRESS

Depot Name:

Address:

Telephone Number:

Primary Contact:

Telephone Number:

Must ALL Orders be accompanied by an order number?

FOURTH DELIVERY ADDRESS

Depot Name:

Address:

Telephone Number:

Primary Contact:

Telephone Number:

Must ALL Orders be accompanied by an order number?

Invoices, POD's and Copies of Signed Worksheets will ONLY be sent to ACCOUNTS ADDRESS entered in '6' Above

Current Fleet Size:

Credit Limit Required:

DECLARATION. ALL Applicants to Sign.

I declare, that to the best of my knowledge, the information I have given above is true and correct:-

Name:

Signature:

Position:

Date: