Client Registration Form

NEW CLIENT REGISTRATION FORM*

(Please note this is not a credit application.) Please complete and return to your account manager. *Required information

NAME / COMPANY NAME*

TRADING AS*

TYPE OF COMPANY*

REGISTRATION / ID NUMBER*

VAT NUMBER*

POSTAL ADDRESS*

PHYSICAL ADDRESS*

CONTACT PERSON*

OFFICE TELEPHONE NUMBER*

DIRECT NUMBER*

EMAIL ADDRESS*

RECEIVE EMAIL MARKETING / PROMOTIONS*

ADDITIONAL CONTACT PERSON*

OFFICE TELEPHONE NUMBER*

DIRECT NUMBER*

ACCOUNTS CONTACT PERSON*

OFFICE TELEPHONE NUMBER*

DIRECT NUMBER*

EMAIL ADDRESS*

UPLOAD BANK CONFIRMATION LETTER*

HOW DID YOU HEAR FROM US?*