Trade Customer Application

Please complete the form below to apply to have an account as a trade customer with EMCO.

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Note: • Required

Title DR MISS MR MRS MS

First Name *

Last Name *

Email Address *

Company Type * Sole Trader Individual Partnership Limited Company Other (please state)

Company Type (Other)

Trading as *

Registered Company Name *

Delivery Address *

Post Code *

Postal Address *

Post Code *

Sales Contact *

Sales Email *

Accounts Contact *

Accounts Email *

Nature of Business *

How Long Established? *

Telephone *

Fax

Website

Ownership 1 Name *

Ownership 1 Residential Address *

Ownership 1 Home Phone No. *

Ownership 1 Mobile No.

Ownership 2 Name

Ownership 2 Residential Address

Ownership 2 Home Phone No.

Ownership 2 Mobile No.

If Limited Liability Company

Address of Registered office

Date of Incorporation

Company No.

Accountants Name and Address

Accountants Phone No.

Solicitors Name and Address

Solicitors Phone No.

Trade References - please list three in total Please supply names and contact addresses and phone numbers

Trade Reference 1 *

Trade Reference 2 *

Trade Reference 3 *

Other Comments

I/We request you open a credit account in our name on the basis that we agree to abide by the conditions of sale. I/We are not an undischarged bankrupt.

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